Manfredi R, Nanetti A, Ferri M, Chiodo F
Dipartimento di Medicina Clinica Specialistica e Sperimentale, Universitai degli Studi di Bologna, Italy.
Eur J Epidemiol. 2000 Feb;16(2):111-8. doi: 10.1023/a:1007626410724.
Two hundred and twenty-four episodes of Pseudomonas spp. complications that occurred in 179 consecutive patients with HIV infection were retrospectively reviewed. Pseudomonas spp. organisms were responsible for 11.6% of 1933 episodes of non-mycobacterial bacterial diseases (5.4% of 1072 episodes of sepsis), observed over an 8-year period; 20.7% of patients experienced disease relapses (45 episodes). These complications mostly involved lower airways (66 cases), urinary tract (53 episodes), and blood (34 cases), with Pseudomonas aeruginosa isolated in 161 episodes, and other Pseudomonas spp. in the remaining 63 cases. An advanced HIV disease was frequently present (as expressed by a prior diagnosis of AIDS, a low CD4+ lymphocyte count, and leukopenia-neutropenia). Indwelling intravascular and urinary catheters were often associated with bacteremia and urinary tract involvement, respectively. More than 60% of patients were given antibiotics and/or cotrimoxazole in the month preceding the onset of Pseudomonas spp. disease. Bacterial strains isolated from our HIV-infected patients showed a favorable sensitivity to piperacillin, ceftazidime, imipenem, amikacin, tobramycin, and ciprofloxacin. An adequate antimicrobial treatment led to clinical and microbiological cure in 73.2% of patients at the first episode, and in 22.3% more subjects after one or more relapses. A lethal outcome occurred in only eight patients of 179 (4.5%), suffering from a far advanced HIV disease; P. aeruginosa infection directly contributed to death in four cases (sepsis, and/or pneumonia). Nosocomial disease occurred in 46.4% of the 224 episodes, and was significantly related to a previous diagnosis of AIDS, concurrent neutropenia, the occurrence of sepsis or urinary tract infection, disease relapses, the involvement of non-aeruginosa Pseudomonas spp., and a lethal outcome, compared with community-acquired infection. Our experience (the largest reported to date) confirms that Pseudomonas spp. (including non-aeruginosa Pseudomonas spp. organisms) is responsible for remarkable morbidity and mortality among patients with HIV infection, and may pose relevant problems to clinicians and microbiologists involved in the care of HIV-infected patients.
对179例连续的HIV感染患者发生的224例假单胞菌属并发症进行了回顾性研究。在8年期间观察到的1933例非分枝杆菌性细菌疾病中，假单胞菌属病原体占11.6%（在1072例败血症中占5.4%）；20.7%的患者经历了疾病复发（45例）。这些并发症主要累及下呼吸道（66例）、泌尿道（53例）和血液（34例），161例分离出铜绿假单胞菌，其余63例分离出其他假单胞菌属。晚期HIV疾病经常存在（以前诊断为艾滋病、CD4 +淋巴细胞计数低以及白细胞减少-中性粒细胞减少可表明）。留置血管内导管和导尿管通常分别与菌血症和泌尿道感染有关。超过60%的患者在假单胞菌属疾病发作前一个月接受了抗生素和/或复方新诺明治疗。从我们的HIV感染患者中分离出的细菌菌株对哌拉西林、头孢他啶、亚胺培南、阿米卡星、妥布霉素和环丙沙星表现出良好的敏感性。充分的抗菌治疗使73.2%的患者在首次发作时实现了临床和微生物学治愈，在一次或多次复发后，又有22.3%的患者实现了治愈。179例患者中只有8例（4.5%）出现致命结局，这些患者患有晚期HIV疾病；铜绿假单胞菌感染在4例患者中直接导致死亡（败血症和/或肺炎）。224例发作中有46.4%发生医院内感染，与社区获得性感染相比，医院内感染与先前诊断为艾滋病、并发中性粒细胞减少、败血症或泌尿道感染的发生、疾病复发、非铜绿假单胞菌属的累及以及致命结局显著相关。我们的经验（迄今为止报道的最大规模研究）证实，假单胞菌属（包括非铜绿假单胞菌属病原体）在HIV感染患者中导致了显著的发病率和死亡率，并且可能给参与HIV感染患者护理的临床医生和微生物学家带来相关问题。
