HIV-Associated Mycobacterium tuberculosis Bloodstream Infection Is Underdiagnosed by Single Blood Culture

• Published in: Journal of clinical microbiology 2018-05, Vol.56 (5)
• Main Authors: Barr, David A, Kerkhoff, Andrew D, Schutz, Charlotte, Ward, Amy M, Davies, Gerry R, Wilkinson, Robert J, Meintjes, Graeme
• Format: Article
• Language: English
• Subjects: Bacteremia - diagnosis; Bacteremia - microbiology; Blood Culture - statistics & numerical data; HIV Infections - complications; Humans; Mycobacteriology and Aerobic Actinomycetes; Mycobacterium tuberculosis - isolation & purification; Prospective Studies; Retrospective Studies; South Africa; Tuberculosis - blood; Tuberculosis - diagnosis
• ISSN: 0095-1137; 1098-660X
• DOI: 10.1128/JCM.01914-17

We assessed the additional diagnostic yield for bloodstream infection (BSI) by doing more than one tuberculosis (TB) blood culture from HIV-infected inpatients. In a retrospective analysis of two cohorts based in Cape Town, South Africa, 72/99 (73%) patients with BSI were identified by the first of two blood cultures during the same admission, with 27/99 (27%; 95% confidence interval [CI], 18 to 36%) testing negative on the first culture but positive on the second. In a prospective evaluation of up to 6 blood cultures over 24 h, 9 of 14 (65%) patients with BSI had grow on their first blood culture; 3 more patients (21%) were identified by a second independent blood culture at the same time point, and the remaining 2 were diagnosed only on the 4th and 6th blood cultures. Additional blood cultures increase the yield for BSI, similar to what is reported for nonmycobacterial BSI.