Trends in Bloodstream Infections among Human Immunodeficiency Virus–Infected Adults Admitted to a Hospital in Nairobi, Kenya, during the Last Decade

Abstract

Bloodstream infections are a frequent complication in human immunodeficiency virus (HIV)-infected adults in Africa and usually associated with a poor prognosis. We evaluated bloodstream infections across a decade in 3 prospective cross-sectional surveys of consecutive medical admissions to the Kenyatta National Hospital, Nairobi, Kenya. Participants received standard clinical care throughout. In 1988-1989, 29.5% (28 of 95) of HIV-positive patients had bloodstream infections, compared with 31.9% (46 of 144) in 1992 and 21.3% (43 of 197) in 1997. Bacteremia and mycobacteremia were significantly associated with HIV infection. Infections with Mycobacterium tuberculosis, non-typhi species of Salmonella (NTS), and Streptococcus pneumoniae predominated. Fungemia exclusively due to Cryptococcus neoformans was uncommon. Clinical features at presentation remained similar. Significant improvements in the survival rate were recorded among patients with NTS bacteremia (20%-83%; P<.01) and mycobacteremia (0%-73%; P<.01). Standard clinical management can improve outcomes in resource-poor settings.

Delay in the presentation of patients to hospital is the main factor for failure to adhere to the Royal College of Physicians’ guidelines in the management of suspected subarachnoid haemorrhage

“…LP is 100% sensitive for up to 14 days post-ictus. 3 However, this and previous studies 4,5 consistently show that a LP is not performed often enough in cases of suspected SAH where CT-scanning shows no abnormality. One example of the necessity of performing a LP is a previous case series of CT-negative suspected SAH, where subsequent LP gave a positive diagnosis in up to 21%.…”

Antimicrobial susceptibility in community-acquired bacterial pneumonia in adults

“…Specimens including sputum, and throat swabs were obtained from each case before treatment was commenced. In addition S. pneumoniae isolates were obtained from bronchoalveolar lavage and blood cultures from a total of 14 patients from two previous studies done at Kenyatta National Hospital and Mbagathi District Hospital (12,13). For the bronchoscopy procedure patients were admitted to the Nairobi Hospital under the respective projects.…”

Epidemiology, Clinical Presentation, Laboratory Diagnosis, Antimicrobial Resistance, and Antimicrobial Management of Invasive Salmonella Infections

“…The reported case fatality ratio among adults appears to have fallen gradually in Africa, after initial reports in the 1980s and 1990s, to around 20 to 25% more recently. This has been attributed largely to improved recognition and more prompt and effective management (191). It is possible but not certain that more-effective antimicrobials, such as fluoroquinolones replacing chloramphenicol, may also have contributed to these improving outcomes (114).…”