Pedro-Botet Ma L, Mòdol J M, Vallés X, Romeu J, Sopena N, Giménez M, Tor J, Clotet B, Sabrià M
Infectious Diseases Unit Hospital Universitario Germans Trias i Pujol, Badalona, Catalonia, Spain.
Int J Infect Dis. 2002 Mar;6(1):17-22. doi: 10.1016/s1201-9712(02)90130-x.
The Hospital Universitario Germans Trias i Pujol is a 600-bed center serving 700,000 inhabitants including 1800 patients with HIV infection in Catalonia (Spain). Highly active antiretroviral therapy (HAART) became available at the end of 1996. Thus, the period 1995 1997 was considered appropriate for evaluating possible epidemiological changes in bloodstream infections (BSI) in HIV-infected patients.
All significant bloodstream infections, including mycobacteremia and fungemia, observed in HIV-positive patients from January, 1995 to December, 1997 have been included in the study.
One hundred and eighty six cases were evaluated, in whom a decrease in BSI was observed (68 in 1995, 86 in 1996, 32 in 1997). Over time, we observed an improvement in the immunologic situation of the patients (1995: CD4 <50/mm3 73.8% vs 1997: CD4 <50/mm3 45.5% (P=0.05)). The source of BSI was known in 80.7% of the episodes. BSI secondary to catheter and respiratory infections prevailed in 1995, whereas an increase in bacteremias related to intravenous drug use, with or without endocarditis, was seen in 1997. The most frequent isolates were Mycobacterium avium intracellulare (23) (MAI), M. tuberculosis (20), Staphylococcus aureus (20), coagulase-negative staphylococci (16), Salmonella spp. (16) and Streptococcus pneumoniae (15). In 1997, a decrease was observed in the isolation of Gram-negatives and Mycobacterium spp. with S. aureus and enterococci prevailing.
The prevalence of bloodstream infections in HIV-positive patients has decreased since the introduction of HAART and the immunologic state has improved. Furthermore there is a trend to a decrease or disappearance of microorganisms, such as Pseudomonas spp., Mycobacterium tuberculosis, MAI or fungi related to severe immunosuppression. Lastly, bacteremia caused by the active use of intravenous drugs remains stable with the highest percentage in Spain.
希门尼斯·普约尔大学医院是一家拥有600张床位的医疗中心，为70万居民提供服务，其中包括西班牙加泰罗尼亚地区的1800名艾滋病毒感染患者。1996年底开始提供高效抗逆转录病毒疗法（HAART）。因此，1995年至1997年这段时间被认为适合评估艾滋病毒感染患者血流感染（BSI）可能出现的流行病学变化。
本研究纳入了1995年1月至1997年12月期间在艾滋病毒阳性患者中观察到的所有严重血流感染，包括分枝杆菌血症和真菌血症。
共评估了186例病例，观察到血流感染有所减少（1995年68例，1996年86例，1997年32例）。随着时间的推移，我们观察到患者的免疫状况有所改善（1995年：CD4<50/mm³的患者占73.8%，而1997年：CD4<50/mm³的患者占45.5%（P=0.05））。80.7%的血流感染病例的感染源已知。1995年，继发于导管和呼吸道感染的血流感染最为常见，而1997年，与静脉吸毒相关的菌血症有所增加，无论是否伴有心内膜炎。最常见的分离菌株为胞内鸟分枝杆菌（23株）（MAI）、结核分枝杆菌（20株）、金黄色葡萄球菌（20株）、凝固酶阴性葡萄球菌（16株）、沙门氏菌属（16株）和肺炎链球菌（15株）。1997年，革兰氏阴性菌和分枝杆菌属的分离率有所下降，金黄色葡萄球菌和肠球菌占主导地位。
自引入HAART以来，艾滋病毒阳性患者的血流感染患病率有所下降，免疫状态有所改善。此外，与严重免疫抑制相关的微生物，如假单胞菌属、结核分枝杆菌、MAI或真菌，有减少或消失的趋势。最后，在西班牙，因静脉吸毒活跃导致的菌血症仍然稳定，占比最高。
