Outcome and reinfection after Staphylococcus aureus bacteraemia in individuals with and without HIV-1 infection: a case-control study.
OBJECTIVE
Individuals infected with HIV-1 are at an increased risk of Staphylococcus aureus bacteraemia (SAB). The aim of this study was to investigate mortality rate and risk of reinfection associated with SAB in HIV-1-infected individuals compared to individuals without HIV-1 infection.


METHODS
University hospital treating a third of the estimated 5000 individuals with HIV infection in Denmark.


METHODS
HIV-1-infected (n=82) and sex-matched and age-matched uninfected (n=163) individuals with SAB in the time period 1 January 1995 to 31 December 2010.


METHODS
30-day and 365-day mortality rate ratio and relative risk of reinfection.


RESULTS
Individuals with HIV had an increased risk of death at day 30 (OR 11.90 (95% CI 2.15 to 65.85)) compared to individuals without HIV. Other factors associated with mortality were age, a foreign device and Pitt score. HIV-related factors did not associate to mortality. During follow-up, there were 43 episodes of reinfection; in individuals with HIV infection at an incidence rate of 7.8 (95% CI 4.7 to 10.9)/100 person-years compared with 2.2 (95% CI 1.2 to 3.2)/100 person-years for individuals without HIV. In multivariate analysis, HIV status (OR 2.91 (95% CI 1.29 to 6.58) and injection drug use (OR 3.51 (95% CI 1.06 to 11.63) were independently associated with an increased risk of reinfection.


CONCLUSIONS
HIV-1 infection is associated with an increased risk of 30-day mortality after SAB and a very high rate of reinfection. Age, a foreign device and Pitt score predicted outcome. For patients infected with HIV, neither CD4 T-lymphocyte counts nor plasma HIV RNA levels were associated with 30-day outcome.


BACKGROUND
The study was approved by the Danish Data Protection Agency (record no. 2007-41-1196).
Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
Bianca
B
Stammler Jaliff
Jenny
J
Dahl-Knudsen
Andreas
A
Petersen
Robert
R
Skov
Thomas
T
Benfield
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000150:complications* / Q000209:etiology / Q000401:mortality; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D060085:Coinfection / Q000150:complications; D003428:Cross Infection / Q000150:complications* / Q000209:etiology / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000150:complications* / Q000209:etiology / Q000401:mortality; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult