title: The impact of bacteraemia on HIV infection. Nine years experience in a large Italian university hospital.
abstract: The object of this case control study was to evaluate the frequency, the risk factors, the microbiological spectrum and the outcome of 249 cases of bacteraemia observed in 209 HIV-infected patients, most them affected by AIDS. The rate of bacteraemia in the total yearly HIV-related admissions increased from 4% in 1985 to 13% in 1993. The more common aetiological agents of bacteraemia were: Staphylococcus aureus (29.7%), non-typhoidal species of Salmonella (14.1%), Staphylococcus epidermidis (10.9%), Streptococcus pneumoniae (8.4%) and Pseudomonas aeruginosa (7.6%). A mixed flora was found in 14% of the episodes. Multivariate analysis of predisposing factors indicated that a low CD4+T-cell count (<0.2 x 10(9)/l) (P=0.01), use of central venous catheters (CVC) (P=0.01) and neutropenia (polymorphonuclear neutrophils <1.0 x 10(9)/l) (P=0.04) were independent risk factors for the development of bacteraemia. Logistic regression did not reveal any association of bacteraemia with intravenous drug abuse (on univariate analysis P=0.04). The response (31.8%). Recurrences to specific therapy was favourable in 170 episodes (68.2%); death occurred in 79 (31.8%). Recurrences arose in 40 patients, 17 (42.5%) of them died. The outcome of bacteraemia was influenced by a low number of CD4+T-cells (P<0.001) but not of polymorphonuclear cells. Our findings suggest that bacteraemia is a relatively common event in HIV-infected patients, especially under particular conditions (e.g. intravenous drug abuse, use of CVC, neutropenia and a low CD4-T-cell count). It requires special attention from physicians who must recognise and treat the condition promptly at an early stage.
authors.affiliation: Department of Infectious Diseases, Catholic University, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Tumbarello
authors.forename: E
authors.initials: E
authors.lastname: Tacconelli
authors.forename: S
authors.initials: S
authors.lastname: Caponera
authors.forename: R
authors.initials: R
authors.lastname: Cauda
authors.forename: L
authors.initials: L
authors.lastname: Ortona
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000382:microbiology; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D000328:Adult; D016470:Bacteremia / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D005260:Female; D006679:HIV Seropositivity / Q000150:complications / Q000453:epidemiology*; D006785:Hospitals, University; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D009503:Neutropenia / Q000175:diagnosis; D011008:Pneumococcal Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology; D011552:Pseudomonas Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology; D012307:Risk Factors; D012480:Salmonella Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology; D013203:Staphylococcal Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology; D013290:Streptococcal Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology; D016896:Treatment Outcome