Bloodstream infections among human HIV-infected adult patients: epidemiology and risk factors for mortality
Abstract number: P1002
Ortega M., Almela M., Soriano A., Marco F., Martínez J., Mallolas J., Gatell J., Muñoz A., Mensa J.
Background: Bloodstream infections are a frequent complication found in HIV-infected patients and are usually associated with a poor prognosis.
Objectives: This study was undertaken to describe the epidemiology and sensitivity pattern of pathogens causing community-acquired (CA) and nosocomial (N) bloodstream infection (BSI) in adult HIV-infected patients along the fifteen last years, to establish risk factors for mortality and hence to give guidance in the choice of empirical antimicrobials.
Methods: The type of study was a retrospective analysis of BSI episodes prospectively collected through a blood culture surveillance program from January 1991 to December 2006. We used non-conditional logistic regression methods with death as dependent variable.
Results: 1,077 (6%) episodes of BSI occurred in HIV-infected patients out of 16,946 total episodes in the period of study. CA and N BSI were 634 (59%) and 443 (41%), respectively. S. pneumoniae and S. aureus were the most frequent pathogens (n = 279, 44%) in CA BSI. Coagulase negative staphylococci and S. aureus were the most frequent microorganisms isolated in N cases (n = 369, 38%). Cotrimoxazole resistance was common in CA and N BSI caused by Gram-negative bacilli (50% and 61%, respectively). However, resistance rates to ceftriaxone were low (3%). Crude mortality accounted for 140 cases (13%). The independent risk factors associated with mortality were: liver cirrhosis (OR: 2.90, 95% CI: 1.555.41, p= 0.001), corticosteroids treatment (OR: 3.51, 95% CI: 1.876.56, p< 0.001), neutropenia (OR: 2.21, 95% CI: 1.154.23, p= 0.02), inappropriate empirical therapy (OR: 2.44, 95% CI: 1.294.65, p= 0.006) and isolate of C. albicans (OR: 7.58, 95% CI: 1.6135.65, p= 0.010).
Conclusions: BSI in adult HIV-infected patients was often caused by Gram-positive pathogens in both CA and N settings. An inappropriate empirical therapy and the presence of other immunosuppressive factors were independent risk factors for mortality. Ceftriaxone could be used as the initial empiric therapy for HIV-infected patients with suspected CA BSI.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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