title: Community-acquired lung respiratory infections in HIV-infected patients: microbial aetiology and outcome.
abstract: We describe the aetiology of community-acquired pneumonia (CAP) in HIV-infected patients, risk factors for bacterial or Pneumocystis jirovecii CAP and prognostic factors of 30-day mortality. This was a prospective observational study of 331 consecutive adult CAP cases in HIV-infected patients (January 2007 to July 2012). 128 (39%) patients had CD4(+) cell counts <200 per mm(3) and 99 (43%) ha HIV RNA levels <200 copies per mL on antiretroviral therapy. Streptococcus pneumoniae was the most frequent microorganism in the group with CD4(+) cell counts ≥ 200 per mm(3); P. jirovecii was the most frequent microorganism in the group with CD4(+) cell counts <200 per mm(3) and in patients with HIV RNA ≥ 200 copies per mL. Predictors of bacterial CAP were: time with symptoms ≤ 5 days (OR 2.6, 95% CI 1.5-4.4), C-reactive protein level ≥ 22 mg·dL(-1) (OR 4.3, 95% CI 2.3-8.2) and hepatitis C virus co-infection (OR 2.3, 95% CI 1.4-3.9). White blood cell count ≤ 4 × 10(12) per L (OR 3.7, 95% CI 1.2-11.5), lactate dehydrogenase (LDH) level ≥ 598 U·L(-1) (OR 12.9, 95% CI 4.2-39.7) and multilobar infiltration (OR 5.8, 95% CI 1.9-19.5) were predictors of P. jirovecii. Overall 30-day mortality was 7%. Appropriate antibiotic treatment (OR 0.1, 95% CI 0.03-0.4), LDH ≥ 598 U·L(-1) (OR 6.2, 95% CI 1.8-21.8) and mechanical ventilation (OR 22.0, 95% CI 6.2-78.6) were the variables independently associated with 30-day mortality. The described predictors may help clinicians to distinguish between bacterial and P. jirovecii pneumonia in patients with suspected or confirmed HIV infection.
authors: Dept of Pneumology, Institut del Tórax, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CIBERes), Barcelona.
authors: Catia
authors: C
authors: Cilloniz
authors: Dept of Pneumology, Institut del Tórax, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CIBERes), Barcelona atorres@clinic.ub.es.
authors: Antoni
authors: A
authors: Torres
authors: Dept of Pneumology, Institut del Tórax, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CIBERes), Barcelona.
authors: Eva
authors: E
authors: Polverino
authors: Dept of Pneumology, Institut del Tórax, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CIBERes), Barcelona.
authors: Albert
authors: A
authors: Gabarrus
authors: Dept of Pneumology, Institut del Tórax, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CIBERes), Barcelona.
authors: Rosanel
authors: R
authors: Amaro
authors: Dept of Pneumology, Institut del Tórax, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CIBERes), Barcelona.
authors: Encarnacion
authors: E
authors: Moreno
authors: Departamento de Medicina Crítica y Cuidados Intensivos, Universidad CES, Medellin Colombia.
authors: Santiago
authors: S
authors: Villegas
authors: Infectious Disease Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona.
authors: Mar
authors: M
authors: Ortega
authors: Infectious Disease Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona.
authors: Josep
authors: J
authors: Mensa
authors: Dept of Microbiology, Barcelona Centre for International Health Research, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors: Maria Angeles
authors: MA
authors: Marcos
authors: Infectious Disease Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona.
authors: Asuncion
authors: A
authors: Moreno
authors: Infectious Disease Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona.
authors: Jose M
authors: JM
authors: Miro
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000737:chemistry; D018791:CD4 Lymphocyte Count; D017714:Community-Acquired Infections / Q000150:complications* / Q000401:mortality*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000382:microbiology*; D015497:HIV-1; D006801:Humans; D008171:Lung Diseases / Q000150:complications* / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D045363:Pneumocystis carinii; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013296:Streptococcus pneumoniae; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents