title: Different clinical presentation of community-onset bacteremia among human immunodeficiency virus-infected and human immunodeficiency virus-uninfected adults in the ED.
abstract: OBJECTIVE
  The objective of this study is to analyze the differences in clinical presentation and outcome of community-onset bacteremia between human immunodeficiency virus (HIV)-infected adults and HIV-uninfected adults visiting the emergency department (ED).
  
  
  METHODS
  A multicenter, case-control study with a ratio of 1:4 was conducted retrospectively over an 8-year period. Demographic characteristics, severity of illness, and clinical outcomes determined from chart records were analyzed.
  
  
  RESULTS
  In total, 74 HIV-infected adults (case patients) and 288 HIV-uninfected adults (control patients) were examined. Significant differences in clinical presentation, severity, and the source of bacteremia as well as bacteremia-causing microorganisms between the case patients and control patients were observed by univariate analyses. Using multivariate analyses, the following variables were positively associated with case patients: male sex (odds ratio [OR], 3.42; P = .01), bacteremia due to endocarditis (OR, 7.68; P = .007), bacteremia due to Salmonella enteritidis (OR, 4.29; P = .03), and comorbidity with chronic hepatitis (OR, 5.65; P < .001). Moreover, several independent risk factors of 28-day mortality were discovered, including inappropriate empirical antibiotic therapy after the ED visit (OR, 9.01; P < .001), an initial syndrome with septic shock (OR, 5.37; P < .001); a Pittsburgh bacteremia score greater than or equal to 4 points at the ED (OR, 4.28; P = .002), severe underlying disease based on McCabe classification (rapid and ultimately fatal; OR, 3.31; P = .002), and bacteremia due to pneumonia (OR, 2.66; P = .03). Of note, HIV infection was not a significant factor affecting 28-day mortality.
  
  
  CONCLUSIONS
  This study demonstrated that the clinical characteristics, the severity, and the character of bacteremia in HIV-infected and uninfected patients varied among community-onset bacteremic patients visiting the ED, despite the limited impact of HIV infection on short-term outcomes.
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan.
authors.forename: Ching-Chi
authors.initials: CC
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, Tainan 710, Taiwan.
authors.forename: Feng-Yuan
authors.initials: FY
authors.lastname: Chu
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan; Department of Medicine, Medical College, National Cheng Kung University, Tainan 704, Taiwan.
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Ko
authors.affiliation: Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan; Department of Medicine, Medical College, National Cheng Kung University, Tainan 704, Taiwan. Electronic address: chich@mail.ncku.edu.tw.
authors.forename: Chih-Hsien
authors.initials: CH
authors.lastname: Chi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D004636:Emergency Service, Hospital; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D004927:Escherichia coli Infections / Q000150:complications / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006505:Hepatitis / Q000150:complications; D006801:Humans; D007710:Klebsiella Infections / Q000150:complications / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012480:Salmonella Infections / Q000150:complications / Q000401:mortality; D012720:Severity of Illness Index; D012737:Sex Factors; D012772:Shock, Septic / Q000150:complications* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000150:complications / Q000401:mortality; D013624:Taiwan; D014552:Urinary Tract Infections / Q000150:complications* / Q000382:microbiology