Bacteremia in hospitalized patients infected with the human immunodeficiency virus: a case-control study of risk factors and outcome.
We reviewed all episodes of nonmycobacterial bacteremias in human immunodeficiency virus (HIV)-infected patients from 1990 to 1991 to determine the incidence, risk factors, and outcome. Forty-five patients had a total of 63 episodes of bacteremia (9% of 689 HIV-related hospitalizations). In this cohort, the median CD4+ lymphocyte count was 17 cells/mm3, 71% had AIDS, and 78% were homosexual men. The most frequently isolated bacteria were Staphylococcus aureus (25%) and coagulase-negative staphylococci (22%). The most common site of infection was intravenous catheter-related, accounting for 35% of the bacteremias. Compared to HIV-infected, nonbacteremic controls, patients with bacteremia detected at admission were more likely to have an indwelling intravenous catheter (p = 0.003) and less likely to be likely zidovudine (p = 0.04). The overall in-hospital mortality rate was 24%. There was no significant difference in the in-hospital mortality rates in bacteremic patients with or without HIV infection. Seventeen patients had more than one episode of bacteremia (71% had recurrence with the same organism). We conclude that bacteremia is a significant problem in HIV-infected persons with low CD4+ lymphocyte counts, often related to the presence of an intravenous catheter; recurrence is common. In addition, HIV infection does not appear to increase the mortality rate for bacteremia.
Fichtenbaum
C J
CJ
Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Dunagan
W C
WC
Powderly
W G
WG
D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology*; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D015497:HIV-1; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D012008:Recurrence; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome