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Bloodstream infections common and deadly in Africa
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Community-acquired bloodstream infections may be associated with high rates of in-hospital fatality in African settings, according to recent study results.
Researchers from Duke University and Tumaini University in Tanzania conducted a meta-analysis of 22 studies in which 58,296 African patients — 15,166 adults and 43,130 children — were admitted to hospitals with a blood test. Bloodstream infections were found in 2,051 adults (13.5%) and 3,527 children (8.2%).
Patients with bloodstream infections had an overall in-hospital case-fatality rate of 18.1%, although fatalities were not recorded in all cases.
The most prevalent isolate in adults and overall was Salmonella enterica, accounting for 29.1% of non-malaria bloodstream infections. Streptococcus pneumonia, the most common isolate in children, accounted for 18.3% of infections.
The researchers identified other common isolates, including Staphylococcus aureus in 9.5% of cases and Escherichia coli in 7.3% of cases. In seven studies that used mycobacterial culture techniques, 166 of 539 isolates (30.7%) were Mycobacterium tuberculosis complex.
The presence of HIV infection was associated with the presence of any bloodstream infection, but especially with S. enterica and M. tuberculosis complex bacteremia, the researchers noted.
Bacterial or fungal bloodstream infections in the differential diagnosis of individuals should be considered for all patients — particularly febrile patients — being admitted to hospitals, according to the researchers. Scaled-up laboratories and increased surveillance activities with regard to bloodstream infections were suggested pathways to better public health outcomes in Africa.
Reddy EA. Lancet Infect Dis. 2010;10:417-432.