Volume 16, Number 10—October 2010
CME ACTIVITY - Research
Bloodstream Infections among HIV-Infected Outpatients, Southeast Asia
Jay K. Varma
, 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
, 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
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 >38◦C | 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.
Page created: September 07, 2011
Page updated: September 07, 2011
Page reviewed: September 07, 2011
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