title: Clinical predictors of the leading pathogens in human immunodeficiency virus-infected adults with community-onset bacteremia in the emergency department: The importance of transmission routes.
abstract: OBJECTIVE
  To investigate the clinical characteristics and pathogens of community-onset bacteremia among human immunodeficiency virus (HIV)-infected adults as well as to establish the clinical predictors of the major microorganisms.
  
  
  METHODS
  An observational cohort study was conducted retrospectively between January 2007 and December 2012. Demographic characteristics and pathogens determined from chart records were analyzed.
  
  
  RESULTS
  Of the 121 eligible HIV adults with bacteremia, there was a male predominance (106 patients, 87.6%); elderly individuals (age ≥ 65 years) accounted for only 2.5% of the study population (3 patients). Of the total microorganisms isolated (n=123), Staphylococcus aureus (55, 44.7%) and Salmonella enterica (17, 13.8%) were the common pathogens. In a multivariate analysis, the leading two significant predictors of S. aureus infection were infective endocarditis (odds ratio, 11.49; p=0.001) and transmission risk with injection drug users (IDUs; odds ratio, 6.22; p=0.001). In addition, transmission risk with men who have sex with men (MSM; odds ratio, 37.49; p=0.001) was the leading clinical predictor of S. enterica infection. In further analyses, a strong linear-by-linear correlation between S. aureus infection and IDU (γ=0.94, p=0.02) as well as between S. enterica infection and MSM (γ=0.96, p=0.01) was evidenced.
  
  
  CONCLUSIONS
  Focusing on the two key pathogens in HIV-infected adults with community-onset bacteremia, IDU was one of independent predictors associated with S. aureus infection, whereas MSM was the leading risk factor of S. enterica infection. Although the proposed predictive model of these pathogens has been not established, a scoring system involving the transmission risk of HIV may be of use for the early identification of these patients for clinicians.
authors.affiliation: Division of Critical Care Medicine, Department of Internal Medicine, Madou Sin-Lau Hospital, Tainan, Taiwan; Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan.
authors.forename: Ching-Chi
authors.initials: CC
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yu-Ju
authors.initials: YJ
authors.lastname: Chou
authors.affiliation: Department of Emergency and Critical Care Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
authors.forename: Jiun-Nong
authors.initials: JN
authors.lastname: Lin
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Feng-Yuan
authors.initials: FY
authors.lastname: Chu
authors.affiliation: Department of Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
authors.forename: Hung-Jen
authors.initials: HJ
authors.lastname: Tang
authors.affiliation: Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
authors.forename: Chung-Hsu
authors.initials: CH
authors.lastname: Lai
authors.affiliation: Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
authors.forename: Hsi-Hsun
authors.initials: HH
authors.lastname: Lin
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chien-Ching
authors.initials: CC
authors.lastname: Hung
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan. Electronic address: winston3415@gmail.com.
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Ko
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016470:Bacteremia / Q000150:complications* / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D000071997:Blood Culture; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000150:complications* / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D004636:Emergency Service, Hospital; D004696:Endocarditis / Q000150:complications; D004697:Endocarditis, Bacterial / Q000150:complications / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012480:Salmonella Infections / Q000150:complications / Q000453:epidemiology; D019779:Salmonella enterica / Q000472:pathogenicity; D012720:Severity of Illness Index; D012737:Sex Factors; D012772:Shock, Septic / Q000150:complications / Q000382:microbiology; D013203:Staphylococcal Infections / Q000150:complications / Q000453:epidemiology; D013211:Staphylococcus aureus / Q000472:pathogenicity; D013624:Taiwan / Q000453:epidemiology; D019562:Viral Load
keywords: Salmonella enterica; Staphylococcus aureus; bacteremia; human immunodeficiency virus