RESUMEN
OBJECTIVE: To assess mortality risk among adults presenting to an African teaching hospital with sepsis and severe sepsis in a setting of high HIV prevalence and widespread ART uptake. METHODS: Prospective cohort study of adults (age ≥16 years) admitted with clinical suspicion of severe infection between November 2008 and January 2009 to Queen Elizabeth Central Hospital, a 1250-bed government-funded hospital in Blantyre, Malawi. Demographic, clinical and laboratory information, including blood and cerebrospinal fluid cultures were obtained on admission. RESULTS: Data from 213 patients (181 with sepsis and 32 with severe sepsis; M:F = 2:3) were analysed. 161 (75.6%) patients were HIV-positive. Overall mortality was 22%, rising to 50% amongst patients with severe sepsis. The mortality of all sepsis patients commenced on antiretroviral therapy (ART) within 90 days was 11/28 (39.3%) compared with 7/42 (16.7%) among all sepsis patients on ART for greater than 90 days (p = 0.050). Independent associations with death were hypoxia (OR = 2.4; 95% CI, 1.1-5.1) and systolic hypotension (OR 7.0; 95% CI: 2.4-20.4). CONCLUSIONS: Sepsis and severe sepsis carry high mortality among hospitalised adults in Malawi. Measures to reduce this, including early identification and targeted intervention in high-risk patients, especially HIV-positive individuals recently commenced on ART, are urgently required.
Asunto(s)
Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Sepsis/mortalidad , Adulto , Antibacterianos/administración & dosificación , Bacteriemia , Ceftriaxona/administración & dosificación , Estudios de Cohortes , Femenino , Infecciones por VIH/complicaciones , Hospitalización , Hospitales Públicos , Humanos , Estudios Longitudinales , Malaui/epidemiología , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Sepsis/complicaciones , Sepsis/diagnóstico , Sepsis/tratamiento farmacológico , Adulto JovenAsunto(s)
Bacteriemia/microbiología , Infección Hospitalaria/microbiología , Femenino , Humanos , MasculinoRESUMEN
Of 840 patients at hospital admission, 2.7% were positive for methicillin-resistant Staphylococcus aureus (MRSA) and 22.3% were positive for methicillin-susceptible S. aureus (MSSA). During the next 8 months, 4.8% of the MSSA-positive patients acquired MRSA with no lineage association. A total of 5.2% of noncarriers acquired MRSA. We find no evidence that colonized hosts are more susceptible to acquiring MRSA.
Asunto(s)
Portador Sano/epidemiología , Portador Sano/microbiología , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Mucosa Nasal/microbiología , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/microbiología , Hospitalización , Humanos , PrevalenciaRESUMEN
INTRODUCTION: The neglected tropical diseases (NTDs) are infectious diseases that principally impact the world's poorest people. They have been neglected for decades, initially as part of a general disregard for the developing world, and more recently due to the intensity of focus on HIV/AIDS, tuberculosis and malaria. SOURCES OF DATA: Primary research and review articles were selected for inclusion using searches of PubMed and our existing collections. RESULTS: There have been recent notable successes in NTD control. Dracunculiasis is approaching eradication. Leprosy and onchocerciasis are in decline. There are ambitious plans to eliminate trachoma and lymphatic filariasis. Investment in NTD control has high rates of economic return. CONCLUSION: Although there are proven strategies to control several NTDs, these diseases continue to cause a massive burden of morbidity. There is urgent need for more basic and operational research, drug and vaccine development, and greater prioritization by governments and international agencies.