A prospective study of community-acquired bloodstream infections among febrile adults admitted to Mulago Hospital in Kampala, Uganda

Abstract

Septicemia is a frequent cause of death in HIV-infected adults in developing countries. Additional prospective studies are needed to determine the etiology of bloodstream infections (BSI) in febrile HIV-infected adults and guide initial evaluation and treatment in this setting. We assessed the prevalence and etiology of community-acquired BSI among 299 consecutive febrile adult medical admissions to Mulago Hospital, Kampala, Uganda, over a 4-month period in 1997. The median age of our patients was 30 years, 159 (53%) were male, and 227 (76%) HIV-1-seropositive. Overall, prevalence of bacteremia or fungemia (1 patient) was 24%. Bacteremia was more frequent in HIV-infected than in uninfected patients (27% versus 15%, respectively; p = .04). Mycobacterium tuberculosis (n = 28), Streptococcus pneumoniae (n = 15) and Salmonella species (n = 13) were the most frequent isolates. All Salmonella and mycobacterial isolates were recovered from HIV-infected patients. Pneumococcal bacteremia was not associated with HIV seropositivity. M. avium complex and M. simiae were isolated from two HIV-infected patients. The rate of mycobacteremia among febrile HIV-infected adults presenting for hospitalization was 13%. Bacteremia and disseminated tuberculosis are frequent causes of morbidity in febrile HIV-infected Ugandan adults. Initial empiric antibiotic coverage in this setting should be targeted toward the pneumococcus and gram-negative enteric bacilli, especially nontyphi Salmonella species. All patients presenting with chronic cough should be evaluated for tuberculosis.

PIP: Septicemia often causes death in HIV-infected adults in developing countries. The prevalence and etiology of community-acquired bloodstream infections (BSI) were measured among 299 consecutive febrile adult medical admissions to Mulago Hospital, Kampala, Uganda, during 4 months in 1997. The 299 patients in the final study sample were of median age 30 years, of whom 159 (53%) were male and 227 (76%) were HIV-1-seropositive. The overall prevalence of bacteremia or fungemia was 24%, with 27% of HIV-infected patients and 15% of uninfected patients being bacteremic. 28 people were infected with Mycobacterium tuberculosis, 15 with Streptococcus pneumoniae, and 13 with Salmonella species; these were the most frequent isolates. All Salmonella and mycobacterial isolates were recovered from HIV-infected patients. Pneumococcal bacteremia was not associated with HIV seropositivity. M. avium complex and M. simiae were isolated from 2 patients infected with HIV. 13% of febrile HIV-infected adults who presented for hospitalization were mycobacteremic. These findings suggest that bacteremia and disseminated tuberculosis (TB) are frequent causes of morbidity in febrile HIV-infected Ugandan adults. Initial empiric antibiotic coverage in this setting should target pneumococcus and gram-negative enteric bacilli, while patients presenting with chronic cough should be evaluated for TB.