Antibiotic Therapy in Adults with Malaria (ANTHEM): High rate of clinically significant bacteremia in hospitalized adults diagnosed with falciparum malaria

Ne Myo Aung, Phyo Pyae Nyein, Thu Ya Htut, Zaw Win Htet, Tint Tint Kyi, Nicholas M. Anstey, Mar Mar Kyi, Josh Hanson

Research output: Contribution to journalArticleResearchpeer-review

Abstract

It has been believed that concomitant bacteremia is uncommon in adults hospitalized with falciparum malaria. Accordingly, the World Health Organization treatment guidelines presently only recommended additional antibacterial therapy in these patients if they have a clinical syndrome compatible with serious bacterial infection. Admission blood cultures were collected from 20 consecutive adults in Myanmar, hospitalized with a positive immunochromato-graphic test and blood film, suggesting a diagnosis of falciparum malaria; four (20%) had bacteremia with a clinically significant pathogen. These case series' data were pooled with a previously published multicenter study from Myanmar which had also collected blood cultures in adults hospitalized with a diagnosis of falciparum malaria. Among 87 patients in the two studies, 13 (15%) had clinically significant bacteremia on admission, with Gram-negative organisms in 10 (77%) and Staphylococcus aureus in the remaining three (23%). Bacteremic patients had more severe disease than non-bacteremic patients (median [interquartile range] respiratory coma acidosis malaria score 2 [1-4] versus 1 [1-2], P = 0.02) and were more likely to die (2/13 [15%] versus 1/74 [1%], P = 0.01). However, bacterial coinfection was suspected clinically in a minority of bacteremic patients (5/13 [38%] compared with 13/70 [19%] of non-bacteremic patients, P = 0.11). Concomitant bacteremia in adults diagnosed with falciparum malaria may be more common than previously believed and is difficult to identify clinically in resource-poor settings. Deathismore common in these patients, suggesting that clinicians should have a lower threshold for commencing empirical antibacterial therapy in adults diagnosed with falciparum malaria in these locations than is presently recommended.

LanguageEnglish
Pages688-696
Number of pages9
JournalAmerican Journal of Tropical Medicine and Hygiene
Volume99
Issue number3
DOIs
StatePublished - 1 Sep 2018

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Falciparum Malaria
Bacteremia
Malaria
Anti-Bacterial Agents
Myanmar
Therapeutics
Respiratory Acidosis
Hematologic Tests
Coma
Coinfection
Bacterial Infections
Multicenter Studies
Staphylococcus aureus
Guidelines

Cite this

Aung, Ne Myo ; Nyein, Phyo Pyae ; Htut, Thu Ya ; Htet, Zaw Win ; Kyi, Tint Tint ; Anstey, Nicholas M. ; Kyi, Mar Mar ; Hanson, Josh. / Antibiotic Therapy in Adults with Malaria (ANTHEM) : High rate of clinically significant bacteremia in hospitalized adults diagnosed with falciparum malaria. In: American Journal of Tropical Medicine and Hygiene. 2018 ; Vol. 99, No. 3. pp. 688-696
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abstract = "It has been believed that concomitant bacteremia is uncommon in adults hospitalized with falciparum malaria. Accordingly, the World Health Organization treatment guidelines presently only recommended additional antibacterial therapy in these patients if they have a clinical syndrome compatible with serious bacterial infection. Admission blood cultures were collected from 20 consecutive adults in Myanmar, hospitalized with a positive immunochromato-graphic test and blood film, suggesting a diagnosis of falciparum malaria; four (20{\%}) had bacteremia with a clinically significant pathogen. These case series' data were pooled with a previously published multicenter study from Myanmar which had also collected blood cultures in adults hospitalized with a diagnosis of falciparum malaria. Among 87 patients in the two studies, 13 (15{\%}) had clinically significant bacteremia on admission, with Gram-negative organisms in 10 (77{\%}) and Staphylococcus aureus in the remaining three (23{\%}). Bacteremic patients had more severe disease than non-bacteremic patients (median [interquartile range] respiratory coma acidosis malaria score 2 [1-4] versus 1 [1-2], P = 0.02) and were more likely to die (2/13 [15{\%}] versus 1/74 [1{\%}], P = 0.01). However, bacterial coinfection was suspected clinically in a minority of bacteremic patients (5/13 [38{\%}] compared with 13/70 [19{\%}] of non-bacteremic patients, P = 0.11). Concomitant bacteremia in adults diagnosed with falciparum malaria may be more common than previously believed and is difficult to identify clinically in resource-poor settings. Deathismore common in these patients, suggesting that clinicians should have a lower threshold for commencing empirical antibacterial therapy in adults diagnosed with falciparum malaria in these locations than is presently recommended.",
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Antibiotic Therapy in Adults with Malaria (ANTHEM) : High rate of clinically significant bacteremia in hospitalized adults diagnosed with falciparum malaria. / Aung, Ne Myo; Nyein, Phyo Pyae; Htut, Thu Ya; Htet, Zaw Win; Kyi, Tint Tint; Anstey, Nicholas M.; Kyi, Mar Mar; Hanson, Josh.

In: American Journal of Tropical Medicine and Hygiene, Vol. 99, No. 3, 01.09.2018, p. 688-696.

Research output: Contribution to journalArticleResearchpeer-review

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