Community and hospital-acquired invasive bacterial infections in hospitalised patients with advanced HIV disease: a prospective study in Kinshasa, DRC.

BACKGROUND: Advanced HIV patients face high mortality, often from invasive bacterial infections (IBI), while rising antimicrobial resistance (AMR) threatens treatment. This study reports IBIs and AMR in hospitalised advanced HIV patients in Kinshasa, Democratic Republic of the Congo (DRC). METHODS: In this prospective study, all patients with blood (BC) or cerebrospinal fluid (CSF) culture on admission or during hospitalisation were eligible to participate. An IBI was defined as a positive blood or CSF culture and categorised as community-acquired IBI if occurring <48h since admission, or hospital-acquired IBI if occurring ≥48h after admission. RESULTS: We included 724 patients over one year. Community-acquired IBI was suspected in 648 hospitalisations and confirmed in 108 (16.7%). The incidence of hospital-acquired IBI was 2.4 per 1000 patient-days. Non-typhoidal Salmonella and K. pneumoniae were the leading cause of community- (46%, 53/116) and hospital-acquired IBI (42%, 10/24), respectively. Ceftriaxone resistance was observed in 80% of Enterobacterales from community-acquired IBI. In-hospital mortality was significantly higher in hospital-acquired IBI (55%) compared to community-acquired IBI (35%, p<0.001) and BC-negative patients (21%, p<0.001). CONCLUSIONS: IBI are frequent in hospitalised advanced HIV patients in DRC, with high mortality and alarming resistance patterns, highlighting the need for carbapenem-sparing strategies.