Presentation and outcome of suspected sepsis in a high-HIV burden, high antiretroviral coverage setting
Autor: | Valerie J. Robertson, Chipo Tachiona, Stella Huo, John Z. Metcalfe, Christopher A. Berger, Chengetai Mpamhanga, David Katzenstein, Trish Magombei, Wendy Chaka, Marcelyn T. Magwenzi |
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Rok vydání: | 2020 |
Předmět: |
Adult
Lipopolysaccharides Male Zimbabwe 0301 basic medicine Microbiology (medical) medicine.medical_specialty Antigens Fungal Tuberculosis Anti-HIV Agents Point-of-Care Systems 030106 microbiology HIV Infections Urine Antimicrobial resistance Article lcsh:Infectious and parasitic diseases Cohort Studies Sepsis 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans lcsh:RC109-216 Prospective Studies 030212 general & internal medicine Prospective cohort study Sepsis in low-income countries HIV-associated sepsis business.industry Hazard ratio General Medicine Emergency department Middle Aged medicine.disease Confidence interval Anti-Bacterial Agents Treatment Outcome Infectious Diseases Ceftriaxone Female business medicine.drug |
Zdroj: | International Journal of Infectious Diseases, Vol 96, Iss, Pp 276-283 (2020) International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases |
ISSN: | 1201-9712 |
Popis: | Objective To define sepsis syndromes in high-HIV burden settings in the antiretroviral therapy (ART) era. Methods We characterized a prospective cohort of adults presenting to a tertiary emergency department in Harare, Zimbabwe with suspected community-acquired sepsis using blood and urine cultures, urine tuberculosis lipoarabinomannan (TB LAM), and serum cryptococcal antigen (CrAg) testing. The primary outcome was 30-day all-cause mortality. Results Of 142 patients enrolled 68% (n = 96/142, 95% confidence interval (CI) [60–75%]) were HIV-positive, 41% (n = 39/96, 95% CI [31–50%]) of whom were ART-naive. Among HIV-positive patients, both opportunistic pathogens (TB LAM-positivity, 36%, 95% CI [24–48%]; CrAg-positivity, 15%, 95% CI [7–23%]) and severe non-AIDS infections (S. pneumoniae urine antigen-positivity 12%, 95% CI [4–20%]; bacteraemia 17% (n = 16/96, 95% CI [9–24%]), of which 56% (n = 9/16, 95% CI [30–80%]) were gram-negative organisms) were common. Klebsiella pneumoniae recovered from blood and urine was uniformly resistant to ceftriaxone, as were most Escherichia coli isolates. Acknowledging the power limitations of our study, we conclude that relative to HIV-negative patients, HIV-positive patients had modestly higher 30-day mortality (adjusted hazard ratio (HR) 1.88, 95% CI [0.78–4.55]; p = 0.16, and 3.59, 95% CI [1.27–10.16], p = 0.02) among those with and without viral suppression, respectively. Conclusion Rapid point-of-care assays provide substantial clinically actionable information in the setting of suspected sepsis, even in areas with high ART coverage. Antimicrobial resistance to first-line antibiotics in high burden settings is a growing threat. |
Databáze: | OpenAIRE |
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