Bloodstream Infections among HIV-Infected Patients | CDC EID

EID Journal Home > Volume 16, Number 10–October 2010
Volume 16, Number 10–October 2010
MEDSCAPE CME ACTIVITY
Bloodstream Infections among HIV-Infected Outpatients, Southeast Asia

Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit. This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians. Medscape, LLC designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation at www.medscapecme.com/journal/eid; (4) view/print certificate.

Learning Objectives

Upon completion of this activity, participants will be able to:

* Describe overall prevalence of bloodstream infections (BSIs) and prevalence of specific BSIs in HIV-infected outpatients, based on a southeast Asian study sample.
* Describe risk factors for overall and specific BSI in HIV-infected persons in that sample.


Medscape CME Editor

Karen L. Foster, MA, Technical Writer/Editor, Emerging Infectious Diseases. Disclosure: Karen L. Foster, MA,has disclosed no relevant financial relationships.

Medscape CME Author

Laurie Barclay, MD, freelance writer and reviewer, Medscape, LLC. Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Disclosure: Jay K. Varma, MD; Kimberly D. McCarthy, MS; Theerawit Tasaneeyapan, MSc; Patama Monkongdee, MSc; Michael Kimerling, MD, MPH; Eng Buntheoun, MD; Delphine Sculier, MD, MSc; Chantary Keo; Praphan Phanuphak, MD, PhD; Nipat Teeratakulpisarn, MD; Nibondh Udomsantisuk, MD; Nguyen H. Dung, MD, MS; Nguyen T.N. Lan, MD, PhD; Nguyen T.B. Yen, MD; and Kevin P. Cain, MD, have disclosed no relevant financial relationships.

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Bloodstream Infections among HIV-Infected Patients | CDC EID




EID Journal Home > Volume 16, Number 10–October 2010
Volume 16, Number 10–October 2010
Research
Bloodstream Infections among HIV-Infected Outpatients, Southeast Asia

Jay K. Varma Comments to Author, Kimberly D. McCarthy, Theerawit Tasaneeyapan, Patama Monkongdee, Michael E. Kimerling, Eng Buntheoun, Delphine Sculier, Chantary Keo, Praphan Phanuphak, Nipat Teeratakulpisarn, Nibondh Udomsantisuk, Nguyen H. Dung, Nguyen T.N. Lan, Nguyen T.B. Yen, and Kevin P. Cain
Author affiliations: Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand (J.K. Varma, T. Tasaneeyapan, P. Monkongdee); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (J.K. Varma, K.D. McCarthy, K.P. Cain); Bill and Melinda Gates Foundation, Seattle, Washington, USA (M.E. Kimerling); Centers for Disease Control and Prevention, Phnom Penh, Cambodia (E. Buntheoun); Sihanouk Hospital Center of Hope, Phnom Penh, (D. Sculier); Institute of Tropical Medicine, Antwerp, Belgium (D. Sculier); Institute Pasteur Cambodia, Phnom Penh (C. Keo); Thai Red Cross AIDS Research Center, Bangkok, Thailand (P. Phanuphak, N. Teeratakulpisarn); Chulalongkorn University, Bangkok (N. Udomsantisuk); and Pham Ngoc Thach Hospital for Tuberculosis and Lung Diseases, Ho Chi Minh City, Vietnam (N.H. Dung, N.T.N. Lan, N.T.B. Yen)

Suggested citation for this article

Abstract
Bloodstream infections (BSIs) are a major cause of illness in HIV-infected persons. To evaluate prevalence of and risk factors for BSIs in 2,009 HIV-infected outpatients in Cambodia, Thailand, and Vietnam, we performed a single Myco/F Lytic blood culture. Fifty-eight (2.9%) had a clinically significant BSI (i.e., a blood culture positive for an organism known to be a pathogen). Mycobacterium tuberculosis accounted for 31 (54%) of all BSIs, followed by fungi (13 [22%]) and bacteria (9 [16%]). Of patients for whom data were recorded about antiretroviral therapy, 0 of 119 who had received antiretroviral therapy for ≥14 days had a BSI, compared with 3% of 1,801 patients who had not. In multivariate analysis, factors consistently associated with BSI were fever, low CD4+ T-lymphocyte count, abnormalities on chest radiograph, and signs or symptoms of abdominal illness. For HIV-infected outpatients with these risk factors, clinicians should place their highest priority on diagnosing tuberculosis.

Bloodstream infections (BSIs) are a major cause of illness in HIV-infected persons. A series of studies, most of which were conducted in sub-Saharan Africa during the 1990s, demonstrated a high prevalence of BSIs (ranging from 10% to 63%) among hospitalized HIV-infected persons who had fever(1–17). In studies that measured clinical outcomes, the in-hospital death rate for patients with a BSI was high (19%–47%). A variety of pathogens cause BSIs in febrile, hospitalized persons with HIV, most notably non-Typhi Salmonella spp. (6%–15%) and Mycobacterium tuberculosis (2%–19%). BSI with M. tuberculosis appears to be particularly lethal, causing death during hospitalization in up to 47% of patients (9). Although untreated BSIs are believed to lead rapidly to severe illness, sepsis, and death, patients with BSIs may be able to be identified before they are ill enough to require hospitalization, potentially improving clinical outcomes. Despite the large number of studies that have evaluated BSIs in HIV-infected persons, all previous studies have focused on patients seeking care at hospitals because of fever and did not evaluate infections among outpatients with or without fever.

Although overall transmission rates have declined and antiretroviral therapy (ART) has become more widely available, HIV infection remains a major public health problem in Southeast Asia (18). Previous studies of BSI in Southeast Asia enrolled only inpatients, and only 1 evaluated a predominantly HIV-infected population (1,19–21). In this study, we prospectively enrolled patients from multiple HIV testing and treatment clinics in Cambodia, Thailand, and Vietnam to assess BSI prevalence, etiology, and risk factors in outpatients with HIV.

Suggested Citation for this Article

Varma JK, McCarthy KD, Tasaneeyapan T, Monkongdee P, Kimerling M, Buntheoun E, et al. Bloodstream infections among HIV-infected outpatients, Southeast Asia. Emerg Infect Dis [serial on the Internet]. 2010 Oct [date cited].
http://www.cdc.gov/EID/content/16/10/1569.htm

DOI: 10.3201/eid1610.091686