Human immunodeficiency virus and the trauma patient: factors influencing postoperative infectious complications.
OBJECTIVE
While immunosuppression 2 degrees to human immunodeficiency virus (HIV) infection should logically render HIV+ trauma victims more prone to infection after injury, little data is available regarding trauma outcome in this group of patients. Since the helper CD4+ lymphocyte count is a marker for progression of HIV-associated diseases, we examined the relationship between CD4+ counts, Injury Severity Score (ISS), and bacterial infectious complications in HIV+ trauma patients.


METHODS
Retrospective review of 56 consecutive HIV+ trauma patients treated at a Level I trauma center.


RESULTS
Nine patients (15%) developed significant infectious complications (four pneumonias, three soft-tissue infections, one urinary tract infection, one wound infection) with no pattern to the causative agents. Evaluation of CD4+ counts, white blood cell counts, serum albumin levels, blood transfusion requirements, and ISS revealed that only the ISS was associated with infectious complications.


CONCLUSIONS
Despite the profound immunosuppression in this group of patients, the incidence of bacterial infectious complications was independent of the CD4+ count (p = 0.958), but was associated with increases in the ISS (p = 0.003).
Guth
A A
AA
Shock and Trauma Unit, Bellevue Hospital Center, New York University Medical Center, NY 10016, USA.
Hofstetter
S R
SR
Pachter
H L
HL
D000328:Adult; D001424:Bacterial Infections / Q000209:etiology / Q000276:immunology*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D006679:HIV Seropositivity / Q000150:complications; D006801:Humans; D016867:Immunocompromised Host; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000276:immunology*; D012189:Retrospective Studies; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000150:complications* / Q000601:surgery