Septicaemia in a population-based HIV clinical cohort in rural Uganda, 1996-2007: incidence, aetiology, antimicrobial drug resistance and impact of antiretroviral therapy
Septicaemia in a population-based HIV clinical cohort in rural Uganda, 1996-2007: incidence, aetiology, antimicrobial drug resistance and impact of antiretroviral therapy
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DOI：
10.1111/j.1365-3156.2010.02528.x
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发表时间：
2010-06-01
影响因子：
3.3
通讯作者：
Grosskurth, H.
中科院分区：
文献类型：
--
作者：
Mayanja, B. N.;Todd, J.;Grosskurth, H.
为了描述败血症的发病率和病因学，在HIV感染者和未感染者的抗菌药物耐药性，以及抗逆转录病毒治疗（ART）对败血症的影响。方法在1996年和2007年之间，我们随访了一个以农村人口为基础的队列HIV感染者和未感染者。确定败血症的病因和发病率以及抗菌药物的耐药性。抗逆转录病毒疗法于2004年问世，并对其对败血症发病率的影响进行了研究。（每1000年）为32.4（95% CI 26.2-40.6），但仅为2.6（95% CI 1.3-6.2），HIV阴性患者和67.1（95%CI 53.4-85.4），在接受抗逆转录病毒治疗的患者中，总发生率为71.5（95% CI 47.1-114.3），尽管ART治疗第一年为121.4（95% CI 77.9-200.4），随后为37.4（95% CI 18.9-85.2）。败血症的发生率与较低的CD 4计数显著相关。最常见的菌株为肺炎链球菌（SPN，n = 68）和非伤寒沙门氏菌（NTS，n = 42）。大多数SPN分离株对头孢曲松和红霉素敏感，而对复方新诺明和青霉素耐药很常见。所有NTS菌株对环丙沙星敏感，但对复方新诺明和氯霉素的耐药性是common.CONCLUSIONS败血症的发病率较高，在HIV感染者比HIV未感染的参与者，它仍然很高，在那些谁开始ART一段时间。开始ART早在较高的CD 4计数可能会导致较低的败血症发病率。最常见的分离株SPN和NTS均对最常用的抗菌药物耐药。非洲需要建立血培养实验室监测系统，以监测抗生素敏感性，并为治疗指南提供信息。
OBJECTIVES 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.