Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok, Thailand. sasisopin.kie＠mahidol.ac.th
Jpn J Infect Dis. 2012;65(1):28-32.
Few studies have described the pattern of bloodstream infections (BSI) among HIV-infected patients in the highly active antiretroviral therapy (HAART) era, particularly in resource-limited settings. A retrospective cohort study was conducted among 140 HIV-infected patients who had a positive blood culture from 2004-2008. Of the 140 patients, 91 (65%) were male with a mean (SD) age of 38 (9.1) years and a median (IQR) CD4 cell count of 32 (9-112) cells/mm(3). Community-acquired infection was detected in 89% of patients. The blood cultures contained Gram-negative bacteria, 40%; fungi, 24%; Mycobacterium spp., 20%; and Gram-positive bacteria, 16%. Common causative pathogens were Cryptococcus neoformans, 21%; Salmonella spp., 15%; and Mycobacterium tuberculosis, 12%. Common focal sites of infection were the central nervous system, 24%; respiratory tract, 20%; and gastrointestinal tract, 18%. CD4 cell count (OR, 0.61 per 50 cells/mm(3) increment; 95% CI, 0.39-0.96; P = 0.031) was the only factor associated with mycobacterial or fungal BSI. The crude mortality was 21%. HAART (OR, 0.23; 95% CI, 0.01-0.77; P = 0.017), focal infection (OR, 0.31; 95% CI, 0.10-0.97; P = 0.044), and complication (e.g., shock) (OR, 9.26; 95% CI, 3.25-26.42; P < 0.001) were the predictive factors of mortality. In conclusion, opportunistic infections are still the leading causes of BSI among HIV-infected patients in the HAART era.
在高效抗逆转录病毒治疗（HAART）时代，很少有研究描述过 HIV 感染者血流感染（BSI）的模式，特别是在资源有限的环境中。我们对 2004 年至 2008 年间血培养阳性的 140 名 HIV 感染者进行了一项回顾性队列研究。在这 140 名患者中，91 名（65%）为男性，平均（标准差）年龄为 38（9.1）岁，中位数（四分位距）CD4 细胞计数为 32（9-112）细胞/mm(3)。89%的患者为社区获得性感染。血培养中包含革兰氏阴性菌，占 40%；真菌，占 24%；分枝杆菌属，占 20%；革兰氏阳性菌，占 16%。常见的病原体为新型隐球菌，占 21%；沙门氏菌，占 15%；结核分枝杆菌，占 12%。常见的感染部位为中枢神经系统，占 24%；呼吸道，占 20%；胃肠道，占 18%。CD4 细胞计数（比值比，每增加 50 个细胞/mm(3)的 0.61；95%置信区间，0.39-0.96；P = 0.031）是分枝杆菌或真菌性 BSI 的唯一相关因素。粗死亡率为 21%。HAART（比值比，0.23；95%置信区间，0.01-0.77；P = 0.017）、局部感染（比值比，0.31；95%置信区间，0.10-0.97；P = 0.044）和并发症（如休克）（比值比，9.26；95%置信区间，3.25-26.42；P < 0.001）是死亡的预测因素。总之，机会性感染仍然是 HIV 感染者在 HAART 时代血流感染的主要原因。
