title: Septicaemia in a population-based HIV clinical cohort in rural Uganda, 1996-2007: incidence, aetiology, antimicrobial drug resistance and impact of antiretroviral therapy.
abstract: OBJECTIVE
  To describe the incidence and aetiology of septicaemia, and antimicrobial drug resistance in HIV-infected and uninfected individuals, and the impact of antiretroviral therapy (ART) on septicaemia.
  
  
  METHODS
  Between 1996 and 2007, we followed up a rural population-based cohort of HIV-infected and uninfected participants. The aetiology and incidence of septicaemia, and antimicrobial drug resistances were determined. ART became available in 2004, and its impact on the incidence of septicaemia was examined.
  
  
  RESULTS
  The overall septicaemia incidence (per 1000 pyrs) was 32.4 (95% CI 26.2-40.6) but was only 2.6 (95% CI 1.3-6.2) in HIV-negative patients and 67.1 (95% CI 53.4-85.4) in HIV-positive patients not on ART. Among those on ART, the overall incidence was 71.5 (95% CI 47.1-114.3), although it was 121.4 (95%CI 77.9-200.4) in the first year on ART and 37.4 (95%CI 18.9-85.2) in the subsequent period. Septicaemia incidence was significantly associated with lower CD4 counts. The commonest isolates were Streptococcus pneumoniae (SPN, n = 68) and Non-typhi salmonellae (NTS, n = 42). Most SPN isolates were susceptible to ceftriaxone and erythromycin, while resistance to cotrimoxazole and penicillin was common. All NTS isolates were susceptible to ciprofloxacin, but resistance to cotrimoxazole and chloramphenicol was common.
  
  
  CONCLUSIONS
  Septicaemia incidence was higher in HIV-infected than in HIV-uninfected participants, and it remained high for some time among those who started ART. Starting ART earlier at higher CD4 counts is likely to lead to lower septicaemia incidence. Both SPN and NTS, the commonest isolates, were resistant to most commonly available antimicrobials. Blood culture laboratory surveillance systems to monitor antibiotic susceptibility and inform treatment guidelines are needed in Africa.
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda. billy.mayanja@mrcuganda.org
authors.forename: B N
authors.initials: BN
authors.lastname: Mayanja
authors.forename: J
authors.initials: J
authors.lastname: Todd
authors.forename: P
authors.initials: P
authors.lastname: Hughes
authors.forename: L
authors.initials: L
authors.lastname: Van der Paal
authors.forename: J O
authors.initials: JO
authors.lastname: Mugisha
authors.forename: E
authors.initials: E
authors.lastname: Atuhumuza
authors.forename: P
authors.initials: P
authors.lastname: Tabuga
authors.forename: D
authors.initials: D
authors.lastname: Maher
authors.forename: H
authors.initials: H
authors.lastname: Grosskurth
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000302:isolation & purification; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D006801:Humans; D015994:Incidence; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012423:Rural Health; D018805:Sepsis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D044966:Anti-Retroviral Agents