title: 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.
authors.affiliation: Department of Medicine, Mulago Hospital and Makerere University, Kampala, Uganda.
authors.forename: F N
authors.initials: FN
authors.lastname: Ssali
authors.forename: M R
authors.initials: MR
authors.lastname: Kamya
authors.forename: F
authors.initials: F
authors.lastname: Wabwire-Mangen
authors.forename: S
authors.initials: S
authors.lastname: Kasasa
authors.forename: M
authors.initials: M
authors.lastname: Joloba
authors.forename: D
authors.initials: D
authors.lastname: Williams
authors.forename: R D
authors.initials: RD
authors.lastname: Mugerwa
authors.forename: J J
authors.initials: JJ
authors.lastname: Ellner
authors.forename: J L
authors.initials: JL
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D017714:Community-Acquired Infections / Q000150:complications / Q000453:epidemiology / Q000209:etiology; D004352:Drug Resistance, Microbial; D005260:Female; D005334:Fever; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications / Q000453:epidemiology* / Q000209:etiology; D014454:Uganda / Q000453:epidemiology