Talaromyces marneffei is the Persistent Overwhelming Bloodstream Infection Pathogen Among HIV Inpatients in Fujian, China

Figures & data

Figure 1 Flow chart of bloodstream infections screening.

Table 1 Baseline Characteristics in HIV Hospitalized Patients with Bloodstream Infection (N = 646)

Variables	2015 (n = 21)	2016 (n = 66)	2017 (n = 93)	2018 (n = 154)	2019 (n = 133)	2020 (n = 116)	2021 (n = 63)	All (n = 646)	P
Age (y), median (range)	37 (21–69)	36 (19–72)	35 (18–88)	37 (18–75)	41 (20–89)	39 (18–74)	39 (21–77)	38 (18–89)	0.038
Male (n, %)	20 (95.24)	55 (83.33)	80 (86.02)	129 (83.77)	120 (90.23)	101 (87.07)	56 (88.89)	561 (86.84)	0.595
CD4 (cells/µL), median (range)	12 (1–240)	14 (1–269)	12 (1–1003)	14 (0–660)	16 (1–579)	18 (1–709)	12 (1–173)	14 (0–1003)	0.246
>200 (n, %)	1 (4.76)	3 (4.55)	5 (5.38)	7 (4.55)	7 (5.26)	7 (6.03)	0 (0)	30 (4.64)
<200 (n, %)	20 (95.24)	63 (95.45)	88 (94.62)	147 (95.45)	126 (94.74)	109 (93.97)	63 (100)	616 (95.36)
CD8 (cells/µL), median (range)	227 (141–1397)	353 (119–1674)	284 (45–1895)	269 (28–1627)	285 (22–2548)	247 (14–1169)	153 (23–1421)	268 (14–2548)	<0.0001
HIVRNA (IU/mL)									0.001
<1×10^5 (n, %)	5 (23.81)	19 (28.79)	52 (55.91)	52 (33.77)	37 (27.82)	40 (34.48)	19 (30.16)	224 (34.67)
>1×10^5 (n, %)	16 (76.19)	47 (71.21)	41 (44.09)	102 (66.23)	96 (72.18)	76 (65.51)	44 (69.84)	422 (65.33)
PCT (ng/mL), median (range)	0.64 (0.03–100)	0.23 (0.04–7.88)	0.07 (0.02–154.07)	0.11 (0.02–82.93)	0.14 (0.02–100)	0.13 (0.02–54.93)	0.11 (0.04–100)	0.12 (0.02–154.07)	<0.0001
CRP (mg/L), median (range)	3.12 (0.91–237.02)	8.12 (0.45–150.74)	7.46 (0.43–279.59)	8.01 (0.35–259.34)	9.34 (0.2–225.29)	7.68 (0.2–284.04)	8.59 (0.27–250.61)	8.57 (0.2–284.04)	0.451

Notes: Quantitative variables are presented as the median (range). Categorical variables are presented as numbers (percentage). n: sample numbers.

Table 2 Characteristics of Bloodstream Infection Among Inpatients with HIV

	Admission Patients (n)	Blood-Cultured Patients (n)	Culture-Positive Patients (n)	Culture Positive Rate (%)	Contamination Rate (%)	Polymicrobial Rate (%)
2015	204	136	21	15.44	0.74	1.47
2016	631	566	66	11.66	1.06	0.35
2017	700	587	93	15.84	3.41	0.85
2018	849	720	154	21.39	1.11	0.97
2019	798	684	133	19.44	2.05	0.58
2020	664	569	116	20.21	0.88	1.23
2021	436	419	63	15.04	2.15	1.67
Total	4282	3681	646	17.55	1.71	0.92

Table 3 The Isolation Rate of Microorganisms in Bloodstream Infection Patients

Year	Microorganisms (n,%)
	Total	TM	Cryp	Myco	Stap	Stre	Ente	Asps	Cand	Others
2015	23 (16.91)	16 (11.76)	5 (3.68)	–	–	–	1 (0.74)	–	–	1 (0.74)
2016	68 (12.01)	47 (8.3)	8 (1.41)	–	3 (0.53)	–	7 (1.24)	–	–	3 (0.53)
2017	100 (17.04)	64 (10.90)	19 (3.24)	–	6 (1.02)	2 (0.34)	5 (0.85)	–	1 (0.17)	3 (0.51)
2018	161 (22.36)	108 (15.00)	24 (3.33)	5 (0.69)	7 (0.97)	2 (0.28)	10 (1.39)	–	1 (0.14)	4 (0.56)
2019	138 (20.18)	87 (12.72)	20 (2.92)	8 (1.17)	5 (0.73)	–	15 (2.19)	–	2 (0.29)	1 (0.15)
2020	123 (21.62)	85 (14.94)	14 (2.46)	5 (0.88)	5 (0.88)	–	10 (1.76)	1 (0.18)	2 (0.35)	1 (0.18)
2021	70 (16.71)	50 (11.93)	7 (1.67)	10 (2.39)	–	–	2 (0.48)	–	1 (0.24)	–
All	683 (18.55)	457 (12.42)	97 (2.64)	28 (0.76)	26 (0.71)	4 (0.11)	50 (1.36)	1 (0.03)	7 (0.19)	13 (0.35)

Abbreviations: TM, Talaromyces marneffei; Cryp, Cryptococcus neoformans; Myco, Mycobacterium spp. (including Nontuberculous mycobacteria and Mycobacterium tuberculosis); Stap, Staphylococcus spp. (including Coagulase negative staphylococcus and Staphylococcus aureus); Stre, Streptococcus spp.; Ente, Enterobacterium spp.; Aspe, Aspergillus; Cand, Candida; Others, microorganisms except above.

Table 4 The Composition of Microorganisms Isolated from Blood Culture (N = 683)

Year	Microorganisms (n, %)
	TM	Cryp	Myco	Stap	Stre	Ente	Aspe	Cand	Others
2015	16 (69.57)	5 (21.74)	–	–	–	1 (4.34)	–	–	1 (4.34)
2016	47 (69.12)	8 (11.76)	–	3 (4.41)	–	7 (10.29)	–	–	3 (4.41)
2017	64 (64.00)	19 (19.00)	–	6 (6.00)	2 (2.00)	5 (5.00)	–	1 (1.00)	3(3.00)
2018	108 (67.08)	24 (14.90)	5 (3.10)	7 (4.35)	2 (1.24)	10(6.21)	–	1 (0.62)	4(2.48)
2019	87 (63.04)	20 (14.49)	8 (5.79)	5 (3.62)	–	15 (10.87)	–	2 (1.45)	1(0.72)
2020	85 (69.11)	14 (11.38)	5 (4.07)	5 (4.07)	–	10 (8.13)	1 (0.81)	2 (1.63)	1(0.81)
2021	50 (71.43)	7 (10.00)	10 (14.29)	–	–	2 (2.86)	–	1 (1.43)	–
All	457 (66.91)	97 (14.20)	28 (4.10)	26 (3.81)	4 (0.59)	50 (7.32)	1 (0.15)	7 (1.02)	13(1.90)

Abbreviations: TM, Talaromyces marneffei; Cryp, Cryptococcus neoformans; Myco, Mycobacterium spp. (including Nontuberculous mycobacteria and Mycobacterium tuberculosis); Stap, Staphylococcus spp. (including Coagulase negative staphylococcus and Staphylococcus aureus); Stre, Streptococcus spp.; Ente, Enterobacterium spp.; Aspe, Aspergillus; Cand, Candida; Others, microorganism except above.

Table 5 Comparison Between Patients with TM BSI and Other Pathogens BSI

	Group A	Group B	Z/χ^2	P
Age>50y (n,%)	93 (20.35)	78 (34.51)	16.162	<0.0001
Male (%)	402 (87.96)	187 (82.74)	3.474	0.062
CD4<200cells/µL (%)	439 (96.06)	200 (88.50)	14.361	<0.0001
HIVRNA>1×10^4IU/mL (%)	398 (87.09)	155 (68.58)	33.604	<0.0001
CRP (g/L), median(range)	8.44 (0.3–279.59)	10.14 (0.27–284.04)	−2.505	0.012
PCT (ng/mL), median(range)	0.13 (0.02–225.11)	0.14 (0.02–154.07)	−0.516	0.606
WBC (×10^9/L), median(range)	3.54 (0.66–18.62)	4.13 (0.29–42.28)	−3.652	<0.0001
HB (g/L), median(range)	92 (41–144)	97 (50–174)	−2.842	0.004
PLT (×10^9/L), median(range)	171 (3–552)	181 (7–864)	−1.14	0.254
ALT (U/L), median(range)	27 (3–278)	26 (3–664)	−0.869	0.385
AST (U/L), median(range)	30 (8–1999)	29 (6–1999)	−0.730	0.465
Cr (µmol/L), median(range)	68 (10–610)	67.5 (31–611)	−0.505	0.614
BUN (mg/dL), median(range)	4.70 (1–60)	4.95 (0–34)	−0.443	0.658

Notes: Group A: Talaromyces marneffei group; Group B: other pathogens except Talaromyces marneffei; Z: Mann–Whitney test; χ²: Pearson Chi-square test.