Etiology of Sepsis in Uganda using a Quantitative PCR-based TaqMan Array Card.

Knowledge of causes of sepsis in sub-Saharan Africa is limited. A better understanding of the microbiology of bloodstream infections could improve outcomes. We used a quantitative PCR (qPCR)-based TaqMan Array Card (TAC) to directly test for 43 targets from whole blood. We analyzed 336 cryopreserved specimens from adult Ugandans with sepsis enrolled in a multi-site study; 84% were HIV-infected. We compared qPCR TAC results with blood culture and determined the association of qPCR with study participant outcomes using logistic regression. The most frequently detected targets were cytomegalovirus (CMV, n=139, 41%), Mycobacterium tuberculosis (TB, n=70, 21%), Plasmodium (n=35, 10%), and Streptococcus pneumoniae (n=31, 9%). Diagnostic performance varied by target with qPCR sensitivity averaging 61±28% and specificity 98±3% versus culture. In multivariable analysis, independent factors associated with in-hospital mortality included CMV viremia (adjusted odds ratio [aOR] 3.2, 95% CI, 1.8-5.5; p<.01) and TB qPCR-positivity, whether blood culture-positive (aOR 4.6, 95% CI, 2.1-10.0; p<.01) or blood culture-negative (aOR 2.9, 95% CI, 1.2-6.9; p=.02). Using qPCR TAC on direct blood specimens, CMV and TB were the most commonly identified targets and were independently associated with increased in-hospital mortality. qPCR TAC screening of blood for multiple targets may be useful to guide triage and treatment of sepsis in sub-Saharan Africa.