Abstract:

Background: Bacterial blood stream infections constitute a significant public-health problem and present an important cause of morbidity and mortality in HIV infected patients. Non-typhoidal salmonella bacteraemia in an AIDS defining disease according to CDC and WHO criteria.

Objectives: To determine the prevalence, pattern and in-hospital mortality of bacteraemia among febrile adult patients admitted at Bugando Medical Centre in Mwanza, Tanzania.

Methods: A cohort study involving 36 consecutive, febrile adult patients admitted at Bugando Medical Centre between June 2011 – December 2011 was done. Demographic and other data were collected using standardized data collection tool. Blood culture was done followed by susceptibility testing using disc diffusion method. HIV testing was also performed as per Tanzania national algorithm and total white blood cell counts and CD4+ counts were determined.

Results: Of 346 febrile adult patients 33 (9.5%) had bacteraemia. The common isolates were salmonella spp 13/33(39.4%), Escherrichia coli 8/33 (24.2%), Streptococcus pneumonia 5/33 (15.2%) and Staphylococcus aureus 4/33 (12.1%). About 12/156 (7.6%) were infected by Salmonella spp compared to 1/90 (0.5%) of non-HIV infected patients (RRR 11.2, p=0.029). Most of the Salmonella spp were 84%, 69.2% and 38% resistant to chloramphenicol, ampicillin and sulphamethaxazole/trimethoprim respectively, whereas 5/8 (62.5%) of the E. coli isolates were resistant to sulfamethoxazole – trimethoprim, gentamicin and ampicillin. For the gram positive bacteria 3/5 (60%) of S. pneumoniae isolates were resistant to sulfamethoxazole-trimethoprin while 2/4 (50%) of S. aureus isolates were resistant to ampicillin. The mortality rate was 86/346 (24.9%) among febrile adult patients.

Conclusion and Recommendations: Bacteraemia is common among febrile adult patients attending Bugando Medical Centre, Salmonella spp is the commonest cause of bacteraemia among HIV infected patients admitted at Bugando Medical Centre. Most of the bacteria isolates were resistant to chloramphericol, ampicillin, gentamicin and sulfamethoxazole-trimethoprim suggesting that empiric use of these antibiotics for coverage of bacteraemia at Bugando Medical Centre should be re evaluated.