Prognosis and clinical evaluation of infection caused by Rhodococcus equi in HIV-infected patients: a multicenter study of 67 cases.
OBJECTIVE
To assess the clinical characteristics and the factors that influenced the prognosis of patients with HIV and infection caused by Rhodococcus equi.


METHODS
Observational, multicenter study in 29 Spanish general hospitals.


METHODS
These hospitals comprised a total of 20,250 beds for acute patients and served a population of 9,716,880 inhabitants.


METHODS
All patients with HIV and diagnosed R equi infection until September 1998.


RESULTS
During the study period, 19,374 cases of AIDS were diagnosed. Sixty-seven patients were included (55 male patients; mean +/- SD age, 31.7 +/- 5.8 years). At the time of diagnosis of R equi infection, the mean CD4+ lymphocyte count was 35/ micro L (range, 1 to 183/ micro L) and the stage of HIV infection was A3 in 10.4% of patients, B3 in 31.3%, C3 in 56.7%, and unknown in 1.5%. R equi was most commonly isolated in sputum (52.2%), blood cultures (50.7%), and samples from bronchoscopy (31.3%). Chest radiographic findings were abnormal in 65 patients (97%). Infiltrates were observed in all of them, with cavitations in 45 patients. The most active antibiotics against the strains isolated were vancomycin, amikacin, rifampicin, imipenem, ciprofloxacin, and erythromycin. After a mean follow-up of 10.7 +/- 12.8 months, 23 patients (34.3%) died due to causes related to R equi infection and 6 other patients showed evidence of progression of the infection. The absence of highly active antiretroviral therapy (HAART) was independently associated with mortality related to R equi infection (relative risk, 53.4; 95% confidence interval, 1.7 to 1,699). Survival of patients treated with HAART was much higher than that of patients who did not receive this therapy.


CONCLUSIONS
Infection by R equi is an infrequent, opportunistic complication of HIV infection and occurs during advanced stages of immunodepression. In these patients, it leads to a severe illness that usually causes a bacteremic, cavitary pneumonia, although HAART can improve the prognosis.
Torres-Tortosa
Manuel
M
hospital Punta de Europa, Algeciras, Spain.
Arrizabalaga
Julio
J
Villanueva
José L
JL
Gálvez
Juan
J
Leyes
María
M
Valencia
M Eulalia
ME
Flores
Juan
J
Peña
José M
JM
Pérez-Cecilia
Elisa
E
Quereda
Carmen
C
D000193:Actinomycetales Infections / Q000188:drug therapy / Q000401:mortality*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000401:mortality*; D011379:Prognosis; D016929:Rhodococcus equi / Q000302:isolation & purification