期刊
INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES
卷 96, 期 -, 页码 276-283出版社
ELSEVIER SCI LTD
DOI: 10.1016/j.ijid.2020.04.004
关键词
HIV-associated sepsis; Sepsis in low-income countries; Antimicrobial resistance
资金
- NIH [D43 TW009539]
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 ARTcoverage. Antimicrobial resistance to first-line antibiotics in high burden settings is a growing threat. (C) Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据