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Volume 16, Number 10—October 2010

CME ACTIVITY

Bloodstream Infections among HIV-Infected Outpatients, Southeast Asia

Jay K. VarmaComments to Author , Kimberly D. McCarthy, Theerawit Tasaneeyapan, Patama Monkongdee, Michael E. Kimerling, Eng Buntheoun, Delphine Sculier, Chantary Keo, Praphan Phanuphak, Nipat Teeratakulpisarn, Nibondh Udomsantisuk, Nguyen H. Dung, Nguyen T.N. Lan, Nguyen T.B. Yen, and Kevin P. Cain
Author affiliations: Author affiliations: Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand (J.K. Varma, T. Tasaneeyapan, P. Monkongdee); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (J.K. Varma, K.D. McCarthy, K.P. Cain); Bill and Melinda Gates Foundation, Seattle, Washington, USA (M.E. Kimerling); Centers for Disease Control and Prevention, Phnom Penh, Cambodia (E. Buntheoun); Sihanouk Hospital Center of Hope, Phnom Penh, (D. Sculier); Institute of Tropical Medicine, Antwerp, Belgium (D. Sculier); Institute Pasteur Cambodia, Phnom Penh (C. Keo); Thai Red Cross AIDS Research Center, Bangkok, Thailand (P. Phanuphak, N. Teeratakulpisarn); Chulalongkorn University, Bangkok (N. Udomsantisuk); Pham Ngoc Thach Hospital for Tuberculosis and Lung Diseases, Ho Chi Minh City, Vietnam (N.H. Dung, N.T.N. Lan, N.T.B. Yen)

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Table A1

Characteristics of 2,009 HIV-infected outpatients and associated BSI, Thailand, Cambodia, and Vietnam, September 2006–July 2008*

Characteristic All, no. (%),
N = 2,009 Have BSI†, no./total (%), n = 58 Do not have BSI, no./total (%), n = 1,951 OR (95% CI)
Demographics
Country of origin
Thailand 630 (31) 5/58 (9) 625/1,951 (32) Referent
Cambodia 945 (47) 31/58 (53) 914/1,951 (47) 4.2 (1.6–11.0)
Vietnam 434 (22) 22/58 (38) 412/1,951 (21) 6.7 (2.5–17.8)
Median age, y (IQR)‡ 31 (27–38) 32 (27–36) 31 (27–38) NS
Male sex
1,019 (51)
40/58 (69)
979/1,951 (50)
2.21 (1.26–3.88)
Medical history
History of injection drug use 255 (13) 15/58 (26) 240/1,950 (12) 2.49 (1.36–4.54)
HIV diagnosed in past 14 d§ 853 (43) 33/58 (57) 820/1,951 (42) 1.80 (1.06–3.05)
Received ART for >14 d 119 (6) 0/58 (0) 119/1,862 (6) 0
Took co-trimoxazole 232 (12) 12/58 (21) 220/1,950 (11) 2.05 (1.07–3.93)
Took other antimicrobial drug
194 (10)
12/58 (21)
182/1,951 (9)
2.54 (1.32–4.87)
Constitutional symptoms¶
Fever 398 (20) 36/58 (62) 362/1,950 (19) 10.54 (4.51–24.65)
Fever lasting >14 d 313 (16) 32/58 (55) 281/1,948 (14) 7.30 (4.29–12.44)
Shaking chills 204 (10) 19/58 (33) 185/1,946 (10) 4.64 (2.63–8.19)
Night sweats 309 (15) 25/58 (43) 284/1,949 (15) 4.44 (2.60–7.58)
Night sweats lasting >14 d
199 (10)
16/57 (28)
183/1,943 (9)
3.75 (2.07–6.82)
Respiratory symptoms
Cough 688 (34) 39/58 (67) 649/1,949 (33) 4.11 (2.36–7.17)
Every day 811 (40) 40/58 (69) 771/1,949 (40) 3.40 (1.93–5.97)
Recently worsened 72 (4) 7/58 (12) 65/1947 (3) 3.97 (1.74–9.09)
Lasting >14 d 380 (19) 22/58 (38) 358/1,946 (18) 2.71 (1.58–4.66)
Difficulty breathing 428 (21) 32/58 (55) 396/1,951 (20) 4.83 (2.85–8.2)
Chest pain
419 (21)
30/58 (52)
389/1,951 (20)
4.30 (2.54–7.29)
Gastrointestinal symptoms
Mouth or throat pain 403 (20) 27/58 (47) 376/1,951 (19) 3.65 (2.15–6.19)
Pain with swallowing 282 (14) 21/58 (36) 261/1,949 (13) 3.67 (2.12–6.37)
Abdominal pain 321 (16) 20/58 (35) 301/1,951 (15) 2.89 (1.66–5.03)
Loss of appetite 471 (23) 38/57 (67) 433/1,951 (22) 7.01 (4.00–12.29)
Nausea or vomiting 250 (12) 22/58 (38) 228/1,950 (12) 4.62 (2.67–7.98)
Diarrhea 185 (9) 19/58 (33) 166/1,949 (9) 5.23 (2.96–9.26)
Diarrhea lasting >14 d
94 (5)
7/58 (12)
87/1,948 (5)
2.94 (1.29–6.66)
Neurologic-muscular symptoms
Lightheadedness 507 (25) 28/58 (48) 479/1,947 (25) 2.86 (1.69–4.84)
Fatigue 875 (44) 48/58 (83) 827/1,949 (42) 6.51 (3.28–12.95)
Muscle weakness 523 (26) 33/58 (57) 490/1,950 (25) 3.93 (2.32–6.68)
Difficulty sleeping 630 (31) 36/58 (62) 594/1,948 (31) 3.73 (2.18–6.39)
Numbness in feet
420 (21)
25/58 (43)
395/1,949 (20)
2.98 (1.75–5.07)
Signs
Temperature >38C 128 (6) 25/58 (43) 103/1,949 (5) 13.58 (7.78–23.68)
Heart rate >100 beats/min 231 (11) 22/58 (38) 209/19,48 (11) 5.08 (2.94–8.81)
Body mass index <18.5 546 (27) 34/58 (59) 512/1,950 (26) 3.98 (2.34–6.77)
Thrush 249 (12) 25/58 (43) 224/1,949 (12) 5.83 (3.41–9.99)
Oral hairy leukoplakia 166 (8) 19/58 (33) 147/1,949 (8) 5.97 (3.37–10.6)
Oral ulcerations 128 (6) 12/58 (21) 116/1,948 (6) 4.12 (2.12–7.99)
Jaundice 15 (1) 3/58 (5) 12/1,949 (1) 8.80 (2.42–32.09)
Any lymphadenopathy# 238 (12) 18/58 (31) 220/1,945 (11) 3.53 (1.99–6.26)
Head and neck lymphadenopathy 181 (9) 18/58 (31) 163/1,945 (8) 4.92 (2.76–8.78)
Papular rash 402 (20) 18/58 (31) 384/1,949 (20) 1.83 (1.04–3.23)
Needle tracks on arms 42 (2) 5/58 (9) 37/1,949 (2) 4.88 (1.84–12.9)
CD4+ T-lymphocyte count
CD4 count, median (IQR) 252 (92–401) 15 (8–50) 261 (102–405) p < 0.01
<50 cells/mm3 350 (17) 44/58 (76) 306/1,934 (16) 16.72 (9.05–30.89)
<100 cells/mm3 529 (26) 50/58 (86) 479/1,934 (25) 18.98 (8.94–40.33)
<200 cells/mm3 810 (40) 53/58 (91) 757/1,934 (39) 16.48 (6.56–41.42)
<250 cells/mm3 988 (49) 53/58 (91) 935/1,934 (48) 11.33 (4.51–28.46)
Karnofsky score <70
85 (4)
7/58 (12)
78/1,945 (4)
3.29 (1.44–7.47)
Hematologic tests
Hemoglobin level <12 g/dL 777 (39) 46/53 (87) 731/1,913 (38) 10.63 (4.77–23.66)
Leukocyte count >12 × 103 cells/µL 1,189 (59) 12/53 (23) 50/1,893 (3) 10.79 (5.35–21.77)
Thrombocyte count <100 × 103cells/µL
145 (7)
11/58 (19)
134/1,951 (7)
3.17 (1.61–6.26)
Chest radiograph
Abnormal chest radiograph 457 (23) 36/58 (62) 421/1,925 (22) 5.85 (3.4–10.04)
Interstitial pattern 82 (4) 10/58 (17) 72/1,951 (4) 5.44 (2.64–11.18)
Any infiltrate 266 (13) 19/58 (33) 247/1,951 (13) 3.36 (1.91–5.91)
Miliary pattern 25 (1) 7/58 (12) 18/1,951 (1) 14.74 (5.90–36.85)
Pleural effusion 39 (2) 4/58 (7) 35/1,951 (2) 4.06 (1.39–11.81)
Mass or nodule 57 (3) 8/58 (14) 49/1,951 (3) 6.21 (2.80–13.8)
Paratracheal adenopathy 70 (3) 14/58 (24) 56/1,951 (3) 10.77 (5.58–20.78)
>1/3 of either lung abnormal 108 (5) 14/58 (24) 94/1,951 (5) 6.29 (3.33–11.87)
Any lower lung field abnormality 194 (10) 22/58 (38) 172/1,951 (9) 6.32 (3.64–10.99)
Any upper lung field abnormality 258 (13) 20/58 (35) 238/1,951 (12) 3.79 (2.17–6.62)

*Characteristics displayed include those postulated to be associated with BSI that were statistically significant in bivariate analysis. BSI, bloodstream infection; OR, odds ratio; CI, confidence interval; IQR, interquartile range; NS, not significant; ART, antiretroviral therapy.
†Patients whose blood culture grew a contaminant or had no growth were classified as having no BSI.
‡Age was analyzed as a continuous variable with an OR calculated by using logistic regression; p = 0.46.
§The exact date of HIV diagnosis was missing for 12 patients.
¶Unless specified, patients were asked about any occurrence of this symptom in the past 24 h.
#Defined as having a peripheral, noninguinal lymph node >1 cm in diameter or a peripheral, inguinal lymph node >2 cm in diameter.

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