Division of Critical Care Medicine, Department of Internal Medicine, Madou Sin-Lau Hospital, Tainan, Taiwan; Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
J Microbiol Immunol Infect. 2018 Jun;51(3):392-400. doi: 10.1016/j.jmii.2016.08.001. Epub 2016 Dec 18.
BACKGROUND/PURPOSE: To investigate the clinical characteristics and pathogens of community-onset bacteremia among human immunodeficiency virus (HIV)-infected adults as well as to establish the clinical predictors of the major microorganisms.
An observational cohort study was conducted retrospectively between January 2007 and December 2012. Demographic characteristics and pathogens determined from chart records were analyzed.
Of the 121 eligible HIV adults with bacteremia, there was a male predominance (106 patients, 87.6%); elderly individuals (age ≥ 65 years) accounted for only 2.5% of the study population (3 patients). Of the total microorganisms isolated (n=123), Staphylococcus aureus (55, 44.7%) and Salmonella enterica (17, 13.8%) were the common pathogens. In a multivariate analysis, the leading two significant predictors of S. aureus infection were infective endocarditis (odds ratio, 11.49; p=0.001) and transmission risk with injection drug users (IDUs; odds ratio, 6.22; p=0.001). In addition, transmission risk with men who have sex with men (MSM; odds ratio, 37.49; p=0.001) was the leading clinical predictor of S. enterica infection. In further analyses, a strong linear-by-linear correlation between S. aureus infection and IDU (γ=0.94, p=0.02) as well as between S. enterica infection and MSM (γ=0.96, p=0.01) was evidenced.
Focusing on the two key pathogens in HIV-infected adults with community-onset bacteremia, IDU was one of independent predictors associated with S. aureus infection, whereas MSM was the leading risk factor of S. enterica infection. Although the proposed predictive model of these pathogens has been not established, a scoring system involving the transmission risk of HIV may be of use for the early identification of these patients for clinicians.
背景/目的：调查人类免疫缺陷病毒（HIV）感染成人社区获得性菌血症的临床特征和病原体，并建立主要微生物的临床预测因子。
本研究采用回顾性队列研究设计，对 2007 年 1 月至 2012 年 12 月期间的病历记录进行分析。
本研究纳入了 121 例符合条件的 HIV 成人菌血症患者，其中男性占优势（106 例，87.6%）；研究人群中仅 2.5%（3 例）为老年人（年龄≥65 岁）。从总共分离出的 123 种微生物中，金黄色葡萄球菌（55 株，44.7%）和肠炎沙门氏菌（17 株，13.8%）是常见病原体。多变量分析显示，金黄色葡萄球菌感染的两个主要显著预测因子是感染性心内膜炎（优势比，11.49；p=0.001）和与静脉注射吸毒者（IDUs）的传播风险（优势比，6.22；p=0.001）。此外，与男男性行为者（MSM）的传播风险（优势比，37.49；p=0.001）是肠炎沙门氏菌感染的主要临床预测因子。进一步分析表明，金黄色葡萄球菌感染与 IDU 之间存在很强的线性相关（γ=0.94，p=0.02），肠炎沙门氏菌感染与 MSM 之间也存在很强的线性相关（γ=0.96，p=0.01）。
在关注 HIV 感染成人社区获得性菌血症的两种主要病原体时，IDU 是与金黄色葡萄球菌感染相关的独立预测因子之一，而 MSM 是肠炎沙门氏菌感染的主要危险因素。虽然尚未建立这些病原体的预测模型，但包含 HIV 传播风险的评分系统可能有助于临床医生早期识别这些患者。
