title: Epidemiology of bloodstream infections and predictive factors of mortality among HIV-infected adult patients in Thailand in the era of highly active antiretroviral therapy.
abstract: Few studies have described the pattern of bloodstream infections (BSI) among  HIV-infected patients in the highly active antiretroviral therapy (HAART) era, particularly in  resource-limited settings. A retrospective cohort study was conducted among 140 HIV-infected  patients who had a positive blood culture from 2004-2008. Of the 140 patients, 91 (65%) were male  with a mean (SD) age of 38 (9.1) years and a median (IQR) CD4 cell count of 32 (9-112) cells/mm(3).  Community-acquired infection was detected in 89% of patients. The blood cultures contained  Gram-negative bacteria, 40%; fungi, 24%; Mycobacterium spp., 20%; and Gram-positive bacteria, 16%.  Common causative pathogens were Cryptococcus neoformans, 21%; Salmonella spp., 15%; and  Mycobacterium tuberculosis, 12%. Common focal sites of infection were the central nervous system,  24%; respiratory tract, 20%; and gastrointestinal tract, 18%. CD4 cell count (OR, 0.61 per 50  cells/mm(3) increment; 95% CI, 0.39-0.96; P = 0.031) was the only factor associated with mycobacterial  or fungal BSI. The crude mortality was 21%. HAART (OR, 0.23; 95% CI, 0.01-0.77; P = 0.017), focal  infection (OR, 0.31; 95% CI, 0.10-0.97; P = 0.044), and complication (e.g., shock) (OR, 9.26;  95% CI, 3.25-26.42; P < 0.001) were the predictive factors of mortality. In conclusion,  opportunistic infections are still the leading causes of BSI among HIV-infected patients in the  HAART era.
authors.affiliation: Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok, Thailand. sasisopin.kie＠mahidol.ac.th
authors.forename: Sasisopin
authors.initials: S
authors.lastname: Kiertiburanakul
authors.forename: Siripen
authors.initials: S
authors.lastname: Watcharatipagorn
authors.forename: Piriyaporn
authors.initials: P
authors.lastname: Chongtrakool
authors.forename: Pitak
authors.initials: P
authors.lastname: Santanirand
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000097:blood* / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality; D018791:CD4 Lymphocyte Count; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality / Q000821:virology; D003454:Cryptococcus / Q000302:isolation & purification / Q000472:pathogenicity; D005260:Female; D016469:Fungemia / Q000382:microbiology / Q000401:mortality; D006090:Gram-Negative Bacteria / Q000302:isolation & purification / Q000472:pathogenicity; D006094:Gram-Positive Bacteria / Q000302:isolation & purification / Q000472:pathogenicity; D015658:HIV Infections / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology