Trends in bloodstream infections among human immunodeficiency virus-infected adults admitted to a hospital in Nairobi, Kenya, during the last decade

Bloodstream infections are a frequent complication in human immunodeficienc y virus (HIV)-infected adults in Africa and usually associated with a poor prognosis. We evaluated bloodstream infections across a decade in 3 prospec tive cross-sectional surveys of consecutive medical admissions to the Kenya tta National Hospital, Nairobi, Kenya. Participants received standard clini cal care throughout. In 1988-1989, 29.5% (28 of 95) of HIV-positive patient s had bloodstream infections, compared with 31.9% (46 of 144) in 1992 and 2 1.3% (43 of 197) in 1997. Bacteremia and mycobacteremia were significantly associated with HIV infection. Infections with Mycobacterium tuberculosis, non-typhi species of Salmonella (NTS), and Streptococcus pneumoniae predomi nated. Fungemia exclusively due to Cryptococcus neoformans was uncommon. Cl inical features at presentation remained similar. Significant improvements in the survival rate were recorded among patients with NTS bacteremia (20%- 83%; P<.01) and mycobacteremia (0%-73%; P<.01). Standard clinical managemen t can improve outcomes in resource-poor settings.