Meynard J-L, Guiguet M, Fonquernie L, Lefebvre B, Lalande V, Honore I, Meyohas M-C, Girard P-M
Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Inserm U 444, Faculté de Médecine Saint-Antoine, and Laboratoire de Bactériologie, Hôpital Saint-Antoine, Paris, France.
HIV Med. 2003 Apr;4(2):127-32. doi: 10.1046/j.1468-1293.2003.00146.x.
The files of all HIV-infected patients hospitalized for an episode of bacteraemia in a 28-bed infectious diseases unit between January 1995 and December 1998 were reviewed. Cases occurring during HAART were compared to cases occurring in patients not receiving HAART. Furthermore, in a case-control study, patients with bacteraemia occurring during HAART were compared with other patients receiving HAART.
There were 74 episodes of bacteraemia in patients not receiving HAART and 31 episodes in patients receiving HAART. The occurrence of bacteraemia fell from 10.5/100 hospitalizations in 1995 to 5.5/100 in 1998 (P = 0.02 trend test). The occurence of P. aeruginosa bacteraemia fell sharply (9/398 vs 1/273, P = 0.05). A significant fall in catheter-related infections was observed between 1995 and 1998 (5.5% vs 1.8%). The two-thirds/one-third distribution of hospital-acquired and community-acquired infections remained stable throughout the period study. In patients receiving HAART, the case-control study showed by multivariate analysis, that a CD4 cell count of less than 100/ micro L [OR = 7.3 (1.9-49.7)], and the use of exogenous devices [OR = 13.3 (2.5-71)] were significantly associated with the risk of bacteraemia.
The introduction of HAART has been associated with a significant fall in the occurrence of bacteraemia. However, patients with a low CD4 cell count remain at risk of bacteraemia with similar microbiological and epidemiological characteristics than in the pre-HAART era.
回顾了1995年1月至1998年12月期间在一家拥有28张床位的传染病科因菌血症发作而住院的所有HIV感染患者的病历。将HAART期间发生的病例与未接受HAART的患者中发生的病例进行比较。此外，在一项病例对照研究中，将HAART期间发生菌血症的患者与其他接受HAART的患者进行比较。
未接受HAART的患者中有74次菌血症发作，接受HAART的患者中有31次发作。菌血症的发生率从1995年的10.5/100次住院降至1998年的5.5/100次（趋势检验P = 0.02）。铜绿假单胞菌菌血症的发生率急剧下降（9/398对1/273，P = 0.05）。1995年至1998年期间观察到导管相关感染显著下降（5.5%对1.8%）。在整个研究期间，医院获得性感染和社区获得性感染的三分之二/三分之一分布保持稳定。在接受HAART的患者中，病例对照研究通过多变量分析显示，CD4细胞计数低于100/μL[比值比（OR）= 7.3（1.9 - 49.7）]以及使用外部装置[OR = 13.3（2.5 - 71）]与菌血症风险显著相关。
HAART的引入与菌血症发生率的显著下降有关。然而，CD4细胞计数低 的患者仍有菌血症风险，其微生物学和流行病学特征与HAART时代之前相似。
