Pseudomonas aeruginosa bacteremia in patients infected with human immunodeficiency virus type 1.
A prospective analysis of 43 episodes of Pseudomonas aeruginosa bacteremia in HIV-1-infected subjects was performed and the results compared with the incidence and outcome of Pseudomonas aeruginosa bacteremia in other high-risk patients, such as transplant recipients, leukemia patients, or patients hospitalized in the intensive care unit. The incidence of bacteremia/fungemia as a whole and of gram-negative and Pseudomonas aeruginosa bacteremia in particular was greater in HIV-1-infected subjects than in the unselected general population admitted. In contrast, the incidence of Pseudomonas aeruginosa bacteremia in HIV-1-infected patients did not differ from that in patients with other high-risk conditions. In patients with HIV-1 infection, independent risk factors for presenting Pseudomonas aeruginosa bacteremia were nosocomial origin (OR, 2.7; 95% CI, 1.3-5.7), neutropenia (OR, 2.7; 95% CI, 1.07-6.8), previous treatment with cephalosporins (OR, 3.6; 95% CI, 1.1-11.6), and a CD4+ cell count lower than 50 cells/mm3 (OR, 3.1; 95% CI, 1.7-8.6). Primary bacteremia and pneumonia were the most common forms of presentation. Fourteen (33%) patients died as a consequence of the bacteremia. The presence of severe sepsis (OR, 17.5; 95% CI, 3.2-68) and the institution of inappropriate definitive antibiotic therapy (OR, 2.7; 95% CI, 1.1-13) were independently associated with a poor outcome. One year after the development of bacteremia, only eight (19%) patients remained alive.
Vidal
F
F
Department of Internal Medicine, Hospital Universitari de Tarragona JOAN XXIII, Faculty of Medicine and Health Sciences, University Rovira i Virgili, Tarragona, Spain. fvidal@galenics.com
Mensa
J
J
Martínez
J A
JA
Almela
M
M
Marco
F
F
Gatell
J M
JM
Richart
C
C
Soriano
E
E
Jiménez de Anta
M T
MT
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000382:microbiology* / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D002648:Child; D015331:Cohort Studies; D005260:Female; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D011550:Pseudomonas aeruginosa; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology