Bloodstream Infections Among HIV-Infected Outpatients, Southeast Asia: Abstract and Introduction

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From Emerging Infectious Diseases
Bloodstream Infections Among HIV-Infected Outpatients, Southeast Asia CME
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; Kevin P. Cain, MD

Authors and Disclosures

CME Released: 09/20/2010; Valid for credit through 09/20/2011

Abstract and Introduction
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.

Introduction
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.

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Bloodstream Infections Among HIV-Infected Outpatients, Southeast Asia: Abstract and Introduction


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Emerging Infectious Diseases CME. 2010;16(10):1569-1575. © 2010 Centers for Disease Control and Prevention (CDC)

Earn Continuing Education Credit from CDC’s Emerging Infectious Diseases® (EID)
Emerging Infectious Diseases® (EID) Journal Articles
CDC’s Emerging Infectious Diseases® journal provides an exceptional opportunity to earn continuing education (CE) with its October articles titled “Changing Epidemiology of Pulmonary Nontuberculous Mycobacterial Disease” and “Bloodstream Infections among Outpatients with HIV, Southeast Asia.” Physicians, physicians’ assistants, nurses, and healthcare professionals can receive CE credit by simply reading this article and answering a series of related, multiple-choice questions that follow. To complete the questions and earn continuing medical education (Medscape CME) credit, please visit www.medscapecme.com/journal/eid.