Incidence and determinants of Pseudomonas aeruginosa infection among persons with HIV: association with hospital exposure.
BACKGROUND
Little information exists on risk factors for Pseudomonas aeruginosa infection in persons with HIV. We assessed the incidence and factors associated with P aeruginosa among persons with HIV enrolled in a large observational cohort study in Los Angeles.


METHODS
Data were analyzed from 4825 persons aged > or =13 years with HIV infection enrolled from 4 outpatient facilities from 1990 to 1998. The association between P aeruginosa infection and demographic, risk behavior, and clinical factors was assessed.


RESULTS
P aeruginosa was diagnosed in 72 (1.5%) patients representing a crude incidence rate of 0.74 per 100 person-years. The most frequent site of infection was pulmonary (47%). In multivariate analysis, prior hospitalization (adjusted rate ratio = 7.9, 95% CI, 3.8-16.2), and both dapsone (adjusted rate ratio = 4.0, 95% CI, 2.2-7.4) and trimethoprim-sulfamethoxazole (adjusted rate ratio = 2.5, 95% CI, 1.2-5.3) use were independently associated with higher rates of infection. Increasing days of inpatient stay (P <.01) and decreasing CD4(+) counts (P <.01) were strongly associated with P aeruginosa. Azithromycin use decreased the risk of infection by nearly 70%.


CONCLUSIONS
Although the overall observed incidence of P aeruginosa was low, hospital exposure, declining CD4(+) levels, and the use of dapsone or trimethoprim-sulfamethoxazole increased the risk of P aeruginosa disease, and azithromycin use was protective in this population. These findings may assist in the early recognition and diagnosis of persons likely to be at increased risk of P aeruginosa infection.
Sorvillo
F
F
Department of Epidemiology, School of Public Health, UCLA, Los Angeles, CA 90095-1772, USA.
Beall
G
G
Turner
P A
PA
Beer
V L
VL
Kovacs
A A
AA
Kerndt
P R
PR
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control / Q000635:transmission; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control / Q000635:transmission; D003622:Dapsone / Q000009:adverse effects; D005260:Female; D015438:Health Behavior; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D017053:Infection Control; D007902:Length of Stay / Q000706:statistics & numerical data; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011552:Pseudomonas Infections / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control / Q000635:transmission; D011550:Pseudomonas aeruginosa; D012307:Risk Factors; D012309:Risk-Taking; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects
D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D017963:Azithromycin; D003622:Dapsone