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Bloodstream infections among human immunodeficiency virus-infected adult patients: epidemiology and risk factors for mortality

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Abstract

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 and to establish risk factors for mortality. 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 a dependent variable. One thousand and seventy-seven episodes of BSI (6%) occurred in HIV-infected patients out of 16,946 episodes during 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 micro-organisms isolated in N cases (n = 169, 38%). Cotrimoxazole resistance was common in CA and N BSI and was 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, p = 0.001), corticosteroids treatment (OR: 3.51, p < 0.001), neutropenia (OR: 2.21, p = 0.02), inappropriate empirical therapy (OR: 2.44, p = 0.006), and isolate of C. albicans (OR: 7.58, p = 0.010). BSI in adult HIV-infected patients was often caused by gram-positive pathogens in both CA and N settings. 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.

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Acknowledgements

We are indebted to Dr. J.M. Gatell and Dr. J.M. Mallolas for their help in the study. This work was supported by grants from the Fundación Máximo Soriano Jiménez of Barcelona.

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Correspondence to M. Ortega.

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Ortega, M., Almela, M., Soriano, A. et al. Bloodstream infections among human immunodeficiency virus-infected adult patients: epidemiology and risk factors for mortality. Eur J Clin Microbiol Infect Dis 27, 969–976 (2008). https://doi.org/10.1007/s10096-008-0531-5

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  • DOI: https://doi.org/10.1007/s10096-008-0531-5

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