Causes of hospitalization and predictors of HIV-associated mortality at the main referral hospital in Sierra Leone: a prospective study

Lakoh, Sulaiman; Jiba, Darlinda F.; Kanu, Joseph E.; Poveda, Eva; Salgado‐Barreira, Ángel; Sahr, Foday; Sesay, Momodu; Deen, Gibrilla F.; Sesay, Tom; Gashau, Wadzani; Salata, Robert A.; Yendewa, George A.

doi:10.1186/s12889-019-7614-3

Cited by 39 publications

(33 citation statements)

References 30 publications

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“…Previous studies in Nigeria [ 19 ], Ghana [ 20 ], Benin [ 21 ], Burkina Faso [ 21 ], Cote d'Ivoire [ 21 ], Mali [ 21 ], Senegal [ 21 ], and Sierra Leone [ 22 ] have similarly reported an AIDS-related death rate of around 30% among hospitalized patients, as in our study. Opportunistic infections are reported in Africa as the leading cause of hospitalization for AIDS-related deaths [ 12 , 23 , 24 ].…”

Section: Discussionsupporting

confidence: 87%

Predictors of AIDS-related death among adult HIV-infected inpatients in Kisangani, the Democratic Republic of Congo

Tepungipame¹,

Tonen‐Wolyec²,

Kalla³

et al. 2020

Pan Afr Med J

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Section: Discussionsupporting

confidence: 87%

Predictors of AIDS-related death among adult HIV-infected inpatients in Kisangani, the Democratic Republic of Congo

Tepungipame¹,

Tonen‐Wolyec²,

Kalla³

et al. 2020

Pan Afr Med J

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“…The high rate of antibiotic use by this cohort could be a predisposing factor to the high levels of resistance observed in this study, although it could also be explained by the effort of service providers to treat the patients' febrile conditions. As with other studies, the high burden of comorbidities especially the HIV/AIDS burden in this hospital [8,24,25] will also have influenced the use of antibiotics by service providers. Although there were existing antibiotic guidelines in this hospital, their use could not provide adequate guidance to the treatment of HAP and CAUTI.…”

Section: Discussionmentioning

confidence: 55%

Antibiotic resistance in patients with clinical features of healthcare-associated infections in an urban tertiary hospital in Sierra Leone: a cross-sectional study

Lakoh

Sevalie

et al. 2020

Antimicrob Resist Infect Control

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Background: Available data on antibiotic resistance in sub-Saharan Africa is limited despite its increasing threat to global public health. As there is no previous study on antibiotic resistance in patients with clinical features of healthcare-associated infections (HAIs) in Sierra Leone, research is needed to inform public health policies. Our study aimed to assess antibiotic resistance rates from isolates in the urine and sputum samples of patients with clinical features of HAIs.Methodology: We conducted a cross-sectional study of adult inpatients aged ≥18 years at Connaught Hospital, an urban tertiary care hospital in Freetown between February and June 2018. Results: Over the course of the study, we enrolled 164 patients. Risk factors for HAIs were previous antibiotic use (93.3%), comorbidities (58.5%) and age (≥65 years) (23.9%). Of the 164 samples, 89.6% were urine. Bacterial growth was recorded in 58.8% of cultured specimens; the type of specimen was an independent predictor of bacterial growth (p < 0.021). The most common isolates were Escherichia coli and Klebsiella pneumoniae; 29.2% and 19.0% in urine samples and 18.8% and 31.3% in sputum samples, respectively. The overall resistance rates were 58% for all extended-spectrum beta-lactamase (ESBL)-producing organisms, 13.4% for carbapenem-resistant non-lactose fermenting gram-negative bacilli, 8.7% for carbapenem-resistant Acinetobacter baumannii (CRAB) and 1.3% for carbapenem-resistant Enterobacteriaceae (CRE). There were no carbapenem-resistant P. aeruginosa (CRPA) isolates but all Staphylococcus aureus isolates were methicillin-resistant S. aureus. Conclusion:We demonstrated a high prevalence rate of ESBL-producing organisms which are a significant burden at the main tertiary hospital in Sierra Leone. Urgent action is needed to strengthen microbiological diagnostic infrastructure, initiate surveillance on antibiotic resistance and develop and implement policy framework on antibiotic stewardship.

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“…These data demonstrate that, although the country is progressing towards reaching the UNAIDS 90-90-90 treatment target, the northern and northeastern regions are no in line with the general trend. Here in the Brazilian Amazon, opportunistic infections continue to be the main causes of death of people living with HIV, which is a similar situation for those coming from cities in other regions with low economic power [14][15][16][17][18][19] .…”

Section: Discussionmentioning

confidence: 83%

Immunologic Biomarkers, Morbidity and Mortality Among HIV Patients Hospitalized in a Tertiary Care Hospital in the Brazilian Amazon

Mota

Almeida

Santos

et al. 2020

Preprint

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Background: While antiretroviral therapy (ART) has significantly improved survival rates of people living with HIV, some regions in Brazil still show a linear trend of growth in the opportunistic infections that cause HIV-associated mortality. We aimed to describe HIV-associated morbidity and mortality among hospitalized medical patients in a tertiary care hospital in Manaus, in the Brazilian Amazon, by investigating clinical data and immunologic biomarkers in order to assess predictive factors of mortality in this patient group. Methods: We prospectively measured concentrations of cytokines Th1/Th2/Th17 and soluble CD14 (sCD14) and reviewed the laboratory parameters and opportunistic infections in outcomes of either death or discharge of eighty-three HIV/AIDS patients who were admitted in 2017-2018 to the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD) in Manaus. Results: The mortality in the sample studied was 20.5%. Tuberculosis (TB) showed a relative risk (RR) =1.86 (confidence interval (CI) 1.14 to 2.81: and p = 0.026), and weight loss was the symptom (RR=1.81; CI: 1.21 to 2.53 and p = 0.007) most highly associated with the death outcome in HIV/AIDS inpatients. Univariable analyses showed that the eosinophil count, platelet distribution width (PDW), and alanine aminotransferase were the only laboratory parameters that differed among patients who died. In relation to cytokines and sCD14 levels, no differences were found between those who died or were discharged. A multivariable logistic regression model was used to predict mortality and showed that individuals with no digestive syndrome (especially the absence of oropharyngeal candidiasis), nor TB are 63% to 76% less likely to die, respectively. In addition, increases in PDW values also decreased the probability of death. Curiously, patients who were discharged showed a trend towards a concomitant increase in PDW and mean platelet volume (MPV) in relation to those who died.Conclusions: Opportunistic infections continue to be major events in morbidity and mortality of HIV/AIDS patients, and the relationship between increased PDW and the likelihood of survival suggests the need for future studies on innate immune response of platelets in HIV/AIDS inpatients.

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Causes of hospitalization and predictors of HIV-associated mortality at the main referral hospital in Sierra Leone: a prospective study

Cited by 39 publications

References 30 publications

Predictors of AIDS-related death among adult HIV-infected inpatients in Kisangani, the Democratic Republic of Congo

Predictors of AIDS-related death among adult HIV-infected inpatients in Kisangani, the Democratic Republic of Congo

Antibiotic resistance in patients with clinical features of healthcare-associated infections in an urban tertiary hospital in Sierra Leone: a cross-sectional study

Immunologic Biomarkers, Morbidity and Mortality Among HIV Patients Hospitalized in a Tertiary Care Hospital in the Brazilian Amazon

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