Bacteremia in adult patients with acquired immunodeficiency syndrome in the northeast of Thailand

Abstract

Bacteremia is a frequent complication found in HIV-infected patients and is usually associated with a poor prognosis. This study was undertaken to describe the bacterial pathogens causing bacteremia in adult Thai HIV-infected patients, and hence to give guidance in the choice of empirical antimicrobials. Blood culture results at Srinagarind Hospital, Khon Kaen during the period January 1996 to December 2001 were retrospectively reviewed. In HIV-infected and HIV-uninfected patients, 172 and 4082 episodes of bacteremia occurred, respectively. In HIV-infected patients, community-acquired and nosocomial bacteremia were found in 78.5% and 21.5%, respectively and most were monomicrobial. Gram-negative bacteria were the main pathogens isolated in both groups of bacteremia. Escherichia coli and methicillin-resistant Staphylococcus aureus were more common pathogens causing nosocomial bacteremia in HIV-infected patients, whereas Acinetobacter spp were more common in HIV-uninfected patients. Salmonella spp, especially Salmonella groups D and B, were the most common (62.2%) pathogen in community-acquired bacteremia in HIV-infected patients whereas Escherichia coli was the most common in HIV-uninfected patients. Only a few episodes of community-acquired bacteremia in HIV-infected patients had identified sources. Co-trimoxazole resistance was common in community-acquired bacteremia caused by Gram-negative bacilli in HIV-infected patients, with Salmonella group B being more resistant to co-trimoxazole than Salmonella group D (statistically significant, p<0.001). However, resistance rates to ceftriaxone and ofloxacin were low. Bacteremia in adult HIV-infected patients was usually caused by Gram-negative bacilli in both community-acquired and nosocomial settings. Salmonella spp was the most common organism identified, especially Salmonella group B and D. Ceftriaxone or fluoroquinolones such as ofloxacin or ciprofloxacin should be used as the initial empiric therapy for HIV-infected patients with suspected bacteremia.