| dc.description.abstract | Mortality in people living with human immunodeficiency virus (PLHIV) remains substantial
in Sub-Saharan Africa. Despite sepsis being the major cause of mortality in PLHIV, its optimal
management remains questionable due to poorly characterized etiological agents as well as
effective antimicrobials. This study aimed to assess etiological agents in PLHIV with sepsis,
antibiotic susceptibility and mortality determinants. A prospective cohort design was
conducted at three referral hospitals in Kilimanjaro region from May-December 2021. Patients
with sepsis were screened for Tuberculosis (TB) using urine lateral flow–lipoarabinomannan
(LF‑LAM) and sputum Xpert®-Mycobacterium tuberculosis (MTB)/rifampicin (RIF) assays.
Microbiological diagnostic tests as well as general clinical laboratory tests were also done.
Anti‑TB and broad-spectrum antibiotics were initiated accordingly. Patients were followed-up
for 28 days. Variables were compared using an independent Chi-Square/t-tests. 98 patients
were enrolled with a mean age of 44 (SD 12.9) years old with 59 (60.2%) being females. The
TB was detected in 36 (36.7%) patients, with LF-LAM detecting 12 cases missed by
XpertMTB/RIF. Isolated pathogens considered also as the cause of sepsis in patients with TB
and those without TB included Staphylococcus aureus (4(11.1%) vs 6(9.7%)), Streptococcus
pneumonia (3(8.3%) vs 2(3.2%)), Cryptococcal Spp. (3(8.3%) vs 2(3.2%)), respectively.
Abnormal CBC, CRP, INR was in 31 (31.6%), 49(50%) and 40 (40.8%), respectively. The S.
aureus isolates demonstrated 90% resistance against cotrimoxazole and low rate (10%) against
gentamicin. Mortality was (9.2%) and was associated with malnutrition (p=0.000), high
MEWS scores (p=0.000), Karnofsky score<50% (p= 0.028) and higher INR values (p=0.025).
Multiple pathogens contributed to sepsis in PLHIV that necessitate frequent use of antibiotics
and leading to high antibiotic-resistance among bacterial isolates. Also, malnutrition and
prolonged INR were considered a risk factor for mortality. | en_US |
