Mycobacterium tuberculosis Bacteremia in a Cohort of HIV-Infected Patients Hospitalized with Severe Sepsis in Uganda-High Frequency, Low Clinical Sand Derivation of a Clinical Prediction Score
Mycobacterium tuberculosis Bacteremia in a Cohort of HIV-Infected Patients Hospitalized with Severe Sepsis in Uganda-High Frequency, Low Clinical Sand Derivation of a Clinical Prediction Score
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DOI：
10.1371/journal.pone.0070305
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发表时间：
2013-08-05
期刊：
影响因子：
3.7
通讯作者：
Scheld, W. Michael
中科院分区：
文献类型：
--
作者：
Jacob, Shevin T.;Pavlinac, Patricia B.;Scheld, W. Michael
背景：当表现为结核分枝杆菌(MTB)菌血症时，临床上播散性MTB感染与其他严重的血液感染相似，常常阻碍早期诊断和潜在挽救生命的抗结核治疗的开始。在一组住院的HIV感染的乌干达严重败血症患者中，我们报告了结核分枝杆菌菌血症患者的频率、管理和转归，并提出了基于临床预测因素的风险评分。方法：我们在两家乌干达医院前瞻性地招募了患有严重败血症的成年患者，并获得了用于结核分支杆菌鉴定的血培养。结果：在368例合并严重败血症综合征的HIV感染者中，86例(23%)有MTB菌血症。结核分枝杆菌菌血症患者外周血中CD_4细胞数显著低于淋巴细胞/mm(3)，P
Background: When manifested as Mycobacterium tuberculosis (MTB) bacteremia, disseminated MTB infection clinically mimics other serious blood stream infections often hindering early diagnosis and initiation of potentially life-saving anti-tuberculosis therapy. In a cohort of hospitalized HIV-infected Ugandan patients with severe sepsis, we report the frequency, management and outcomes of patients with MTB bacteremia and propose a risk score based on clinical predictors of MTB bacteremia.Methods: We prospectively enrolled adult patients with severe sepsis at two Ugandan hospitals and obtained blood cultures for MTB identification. Multivariable logistic regression modeling was used to determine predictors of MTB bacteremia and to inform the stratification of patients into MTB bacteremia risk categories based on relevant patient characteristics.Results: Among 368 HIV-infected patients with a syndrome of severe sepsis, eighty-six (23%) had MTB bacteremia. Patients with MTB bacteremia had a significantly lower median CD4 count (17 vs 64 lymphocytes/mm(3), p