Profile of non-typhoidal salmonella bacteraemia in adults with HIV infection admitted to Chris Hani Baragwanath Academic Hospital

Abstract

Background: In sub-Saharan Africa, non-typhoidal salmonella (NTS) has emerged as an important cause of invasive bloodstream infections, especially among human immunodeficiency virus (HIV) infected adults. South Africa has one of the highest burdens of HIV disease in Africa. Literature shows invasive NTS as a well-established disease amongst HIV infected adults with mortality rates of 20-47% in sub-Saharan Africa. However, limited data exists for NTS bacteraemia in South Africa. Aim: Profile NTS bacteraemia in HIV infected adults admitted to Chris Hani Baragwanath Academic Hospital from 2014-2015 examining demographic and clinical profile, sites of infection, antibiotics used, CD4 counts, viral loads and outcomes. Methods: Retrospective review of patient records with positive NTS isolates on blood cultureResults: A total of 69 patients (53.6% male, n=37) were included in the study and consisted predominantly of Black Africans (98.5%, n=68). The mean age (± SD) at presentation was 44 years ±12.39. A total 73.5% (n=50) of patients were empirically started on appropriate antibiotics on admission prior to blood culture results. Ceftriaxone was the most used antibiotic (56.5%, n=39), followed by ciprofloxacin (36%, n=25) and co-amoxiclav (33%, n=23). Trimethoprim/ sulfamethoxazole was used in 20% (n=14) of patients for empiric Pneumocystis jiroveci pneumonia (PJP) cover. Of the 69 patients, 71% (n=49) had CD4 counts < 200 cells/μL, of which 39.1% (n=27) had CD4 counts < 50 cells/ μL. Of note, 75.4% (n=52) were newly diagnosed with HIV and anti-retroviral therapy naive. The mortality rate was 25% (n=18). A GCS<15 and presence of renal dysfunction were associated with mortality. In multivariable analyses, a GCS<15 independently predicted death, with patients with GCS<15 having 15.7 times greater likelihood of dying than fully conscious patients [adj OR 15.69 (3.43- 71.78) p= <0.001]. Men were 4.7 times more likely to die compared to women [adj OR 4.69 (1.09 – 20.99) p=0.043]. Patients treated with inappropriate antibiotics (n=7) were shown to have 3.2 times greater likelihood of dying than those treated with appropriate antibiotics [adj OR 3.20 (0.75- 13.61) p= 0.117].Conclusion: Invasive NTS was more prevalent in advanced HIV infected patients with a 25% mortality rate.