Ortega M, Almela M, Soriano A, Marco F, Martínez J A, Muñoz A, Peñarroja G, Mensa J
Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.
Eur J Clin Microbiol Infect Dis. 2008 Oct;27(10):969-76. doi: 10.1007/s10096-008-0531-5. Epub 2008 May 1.
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.
本研究旨在描述成年HIV感染患者社区获得性（CA）和医院获得性（N）血流感染（BSI）的病原体流行病学及药敏模式，并确定死亡的危险因素。研究类型为对1991年1月至2006年12月通过血培养监测项目前瞻性收集的BSI病例进行回顾性分析。我们使用非条件逻辑回归方法，将死亡作为因变量。在研究期间的16946例病例中，1077例（6%）BSI发生在HIV感染患者中。CA和N BSI分别为634例（59%）和443例（41%）。肺炎链球菌和金黄色葡萄球菌是CA BSI中最常见的病原体（n = 279，44%）。凝固酶阴性葡萄球菌和金黄色葡萄球菌是N病例中最常分离出的微生物（n = 169，38%）。复方新诺明耐药在CA和N BSI中很常见，且由革兰氏阴性杆菌引起（分别为50%和61%）。然而，对头孢曲松的耐药率较低（3%）。粗死亡率为140例（13%）。与死亡相关的独立危险因素为：肝硬化（OR：2.90，p = 0.001）、皮质类固醇治疗（OR：3.51，p < 0.001）、中性粒细胞减少（OR：2.21，p = 0.02）、不恰当的经验性治疗（OR：2.44，p = 0.006）以及白色念珠菌分离株（OR：7.58，p = 0.010）。成年HIV感染患者的BSI在CA和N情况下通常由革兰氏阳性病原体引起。不恰当的经验性治疗和其他免疫抑制因素的存在是死亡的独立危险因素。头孢曲松可作为疑似CA BSI的HIV感染患者的初始经验性治疗药物。
