Non-Salmonella Bacteremia Among Seropositive Hiv Patients Attending Three Tertiary Hospital In Nasarawa State, Nigeria.

Abstract

Background: Bacterial blood stream infections constitute a significant public-health problem and it is an important cause of morbidity and mortality in HIV infected patients. Little is known in developing countries regarding salmonella bacteraemia among HIV patients. The purpose of this study was to determine the bacterial pathogens causing blood stream infection among febrile adults attending three medical centers in Nasarawa State. Methods: A prospective cross-sectional study involving 346 consecutive, febrile adult patients admitted at three medical centers in Nasarawa State, was conducted. Demographic and other data were collected using standardized questionnaires. Blood culture was done followed by susceptibility testing using disc diffusion method. HIV testing was also performed as per Nigeria national algorithm and total white blood cell counts and CD4+ counts determined. Results: Of 346 febrile adult patients 33 (9.5%) had blood stream infections. The common isolates were Salmonella spp 13(39.4%), Escherichia coIi 8 (24.2%), Streptococcus pneumonia 5(15.2%), Staphylococcus aureus 4(12.1%), Citrobacter spp 1(3%), Streptococcus pyogenes 1(3%) and Kiebsiella pneumonia 1(3%). A total of 156 (45.1%) patients were HIV infected; of whom 12/1 56 (7.6%) were infected by non-typhoid Salmonella spp compared to 1/190 (0.5%) of non-HIV infected patients (RRR 11.2, p=0.029) infected with Salmonella typhi. HIV infected patients with bacteremia had significantly lower CD4+ count than those without bacteremia (median 28 vs. 88 cells/mI, p=0.01). Patients with salmonella bacteremia had significantly lower median of WBC than those with non-salmonella as well as those without bacteremia (median, 3.6 vs. 17.5 vs. 9.8x109, p0.0001). All Salmonella spp were sensitive to ceftriaxone and imipenem, while being 84%, 69.2%, 38% and 8% resistant to chloramphenicol, ampicillin, sulphamethaxazole/trimethoprim and ciprofloxacin respectively. Predictors of mortality were HIV infection (OR 2.3, p=0.005), Glasgow coma score of less than 15 (OR 3.4, p=0.0001) and night sweats (OR 2.4, p=0.014). Conclusion: Non-typhoid Salmonella spp that are highly resistant to common antibiotics are predominant cause of bacterial blood stream infection among HIV patients attending Three tertiary medical centers in Nasarawa State. Continuous surveillance and intervention strategies should be put in place to monitor and manage cases of bloodstream infections in HIV-positive patients in  Nasarawa state.