Epidemiology and microbiology of cellulitis and bacterial soft tissue infection during HIV disease: a 10-year survey.
BACKGROUND
Cellulitis and soft tissue infection are underestimated complications of HIV disease.


METHODS
Sixty-seven bacteriologically proven consecutive episodes were identified among 2221 HIV-infected patients hospitalized in a 10-year period, and assessed according to several epidemiological, microbiological and clinical variables.


RESULTS
Staphylococcus aureus was the most frequently cultured pathogen (50% of 92 isolates), followed by Pseudomonas spp., Escherichia coli and Streptococcus pyogenes; a polymicrobial infection was present in 38.1% of episodes. Drug addiction (p < 0.003) and male gender (p < 0.04) were significantly associated with the occurrence of these complications, which were community-acquired in 83.6% of cases. While a remarkable variation in the severity of underlying immunodeficiency was shown, hematogenous dissemination occurred in 25.4% of episodes, and proved significantly related to a low CD4+ lymphocyte count, and neutropenia. A 21.7% methicillin-resistance rate was shown among S. aureus isolates. All episodes were favorably treated in 5-16 days, in over 60% of cases with associated beta-lactam-aminglycoside antibiotics; a recurrence of staphylococcal cellulitis occurred in four patients only.


CONCLUSIONS
Skin and soft tissue infections are continuing causes of morbidity in HIV-infected patients, even in the highly active antiretroviral therapy era.
Manfredi
Roberto
R
Department of Clinical and Experimental Medicine, Division of Infectious Diseases, University of Bologna, S. Orsola Hospital, Bologna, Italy. manfredi@med.unibo.it
Calza
Leonardo
L
Chiodo
Francesco
F
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000473:pathology; D000328:Adult; D001419:Bacteria / Q000302:isolation & purification* / Q000472:pathogenicity; D002481:Cellulitis / Q000453:epidemiology* / Q000382:microbiology* / Q000473:pathology; D005260:Female; D006785:Hospitals, University; D006801:Humans; D016867:Immunocompromised Host; D007558:Italy / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000473:pathology