mGem: Sepsis and antimicrobial resistance in the context of advanced HIV disease

Area of Science:

• Infectious Diseases
• HIV Medicine
• Critical Care Medicine

Background:

• Sepsis, often stemming from bloodstream infections (BSI), is a major cause of death in individuals with advanced HIV disease (AHD).
• The specific incidence, causes, and outcomes of BSI in AHD patients remain inadequately understood.
• Existing data suggest a heightened susceptibility to BSI, including those caused by antimicrobial-resistant (AMR) organisms, and increased mortality in this population.

Purpose of the Study:

• To review current evidence on the incidence, etiology, and outcomes of BSI in hospitalized patients with AHD.
• To highlight the increased risk and mortality associated with BSI in AHD.
• To identify knowledge gaps and underscore the need for further research.

Main Methods:

• A comprehensive review of existing literature and evidence concerning BSI in patients with advanced HIV disease.
• Analysis of data on risk factors, causative pathogens, and mortality rates associated with BSI in this specific demographic.
• Synthesis of findings to define the current understanding and identify areas requiring further investigation.

Main Results:

• Patients with AHD face an elevated risk of BSI, with a notable prevalence of antimicrobial-resistant (AMR) pathogens.
• Mortality rates linked to BSI are significantly higher in individuals with AHD compared to other populations.
• The identified pathogens causing BSI are evolving, potentially influenced by increased antiretroviral therapy coverage and global AMR trends.

Conclusions:

• Further research is essential to better define BSI epidemiology and outcomes in AHD patients.
• Developing and refining interventions for BSI prevention and management during and after hospitalization is critical.
• Targeted strategies are needed to reduce sepsis-related mortality in the AHD population.