A hospital-based prevalence survey of bloodstream infections in febrile patients in Malawi: Implications for diagnosis and therapy

The etiology of bloodstream infections (BSIs) in febrile (greater than or e qual to 37.5 degrees C) adults (greater than or equal to 18 years old) in o ne Malawi hospital were determined during August and September 1997. After clinical evaluation, blood was drawn for comprehensive culture, human immun odeficiency virus (HIV) type 1 testing, and malaria smear. Of 233 patients, 173 (74%) were HIV-1 infected, and 70 (30%) had BSI. BSI pathogens include d 25 (33%) Streptococcus pneumoniae and 21 (28%) Mycobacterium tuberculosis . Nine patients (4%) had malaria parasitemia, BSIs were more likely in HIV- 1-positive than in -negative patients (62/173 vs, 8/60, P < .01). Clinical predictors of BSI included HIV-1 infection and altered mental status. Morta lity among inpatients with BSI was higher than among those without BSI (P < .001). In conclusion, S. pneumoniae and M. tuberculosis are frequent cause s of BSI in febrile adults. Similar surveys, performed periodically in deve loping countries, may assist in the identification of clinical predictors o f BSI and in planning appropriate therapy.