ArticlePloS one2014
A reduction in adult blood stream infection and case fatality at a large African hospital following antiretroviral therapy roll-out.
Article in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 3 of them syntheses that pooled it.
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Who cites it
28 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Complications and mortality of non-typhoidal salmonella invasive disease: a global systematic review and meta-analysis.The Lancet. Infectious diseases · 2022Pooled it
- The global burden of non-typhoidal salmonella invasive disease: a systematic analysis for the Global Burden of Disease Study 2017.The Lancet. Infectious diseases · 2019Pooled it
- A Systematic Review of the Incidence, Risk Factors and Case Fatality Rates of Invasive Nontyphoidal Salmonella (iNTS) Disease in Africa (1966 to 2014).PLoS neglected tropical diseases · 2017Pooled it
- Review
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- A Longitudinal, Observational Study of Etiology and Long-Term Outcomes of Sepsis in Malawi Revealing the Key Role of Disseminated Tuberculosis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2022Observational
- Impact and effectiveness of 13-valent pneumococcal conjugate vaccine on population incidence of vaccine and non-vaccine serotype invasive pneumococcal disease in Blantyre, Malawi, 2006-18: prospective observational time-series and case-control studies.The Lancet. Global health · 2021Observational
- Staged progression epidemic models for the transmission of invasive nontyphoidalMathematical biosciences and engineering : MBE · 2021Article
- Prevalence, distribution and antimicrobial susceptibility pattern of bacterial isolates from a tertiary Hospital in Malawi.BMC infectious diseases · 2021Article
- Sustained Reduction in Third-generation Cephalosporin Usage in Adult Inpatients Following Introduction of an Antimicrobial Stewardship Program in a Large, Urban Hospital in Malawi.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Article
- Emerging Resistance to Empiric Antimicrobial Regimens for Pediatric Bloodstream Infections in Malawi (1998-2017).Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2019Article
- Multidrug-resistant Nontyphoidal Salmonella Hotspots as Targets for Vaccine Use in Management of Infections in Endemic Settings.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2019Article
- Invasive NontyphoidalEcoSal Plus · 2019Review
- The epidemiology of febrile illness in sub-Saharan Africa: implications for diagnosis and management.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2018Review
- Trends in antimicrobial resistance in bloodstream infection isolates at a large urban hospital in Malawi (1998-2016): a surveillance study.The Lancet. Infectious diseases · 2017Article
- Vaccinations for the HIV-Infected Adult: A Review of the Current Recommendations, Part II.Infectious diseases and therapy · 2017Review
- Article
- Observational
- Article
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Authors and funding
15 authors.
Funding
Abstract
introductionBlood-stream infection (BSI) is one of the principle determinants of the morbidity and mortality associated with advanced HIV infection, especially in sub-Saharan Africa. Over the last 10 years, there has been rapid roll-out of anti-retroviral therapy (ART) and cotrimoxazole prophylactic therapy (CPT) in many high HIV prevalence African countries.
methodsA prospective cohort of adults with suspected BSI presenting to Queen's Hospital, Malawi was recruited between 2009 and 2010 to describe causes of and outcomes from BSI. Comparison was made with a cohort pre-dating ART roll-out to investigate whether and how ART and CPT have affected BSI. Malawian census and Ministry of Health ART data were used to estimate minimum incidence of BSI in Blantyre district.
results2,007 patients were recruited, 90% were HIV infected. Since 1997/8, culture-confirmed BSI has fallen from 16% of suspected cases to 10% (p<0.001) and case fatality rate from confirmed BSI has fallen from 40% to 14% (p<0.001). Minimum incidence of BSI was estimated at 0.03/1000 years in HIV uninfected vs. 2.16/1000 years in HIV infected adults. Compared to HIV seronegative patients, the estimated incidence rate-ratio for BSI was 80 (95% CI:46-139) in HIV-infected/untreated adults, 568 (95% CI:302-1069) during the first 3 months of ART and 30 (95% CI:16-59) after 3 months of ART.
conclusionsFollowing ART roll-out, the incidence of BSI has fallen and clinical outcomes have improved markedly. Nonetheless, BSI incidence remains high in the first 3 months of ART despite CPT. Further interventions to reduce BSI-associated mortality in the first 3 months of ART require urgent evaluation.
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