University of Genova (DISSAL), Infectious Diseases Clinic, Policlinico Hospital San Martino, Genova, Italy.
Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Sci Rep. 2019 Apr 1;9(1):5418. doi: 10.1038/s41598-019-41829-3.
Retrospective multicentre study aiming at analysing the etiology, characteristics and outcome of bloodstream infections (BSI) in people living with HIV (PLWHIV) in an era of modern antiretroviral therapy. Between 2008 and 2015, 79 PLWHIV had at least 1 BSI, for a total of 119 pathogens isolated. Patients were mainly male (72.1%), previous intravenous drug users (55.7%), co-infected with HCV or HBV (58.2%) and in CDC stage C (60.8%). Gram-positive (G+) pathogens caused 44.5% of BSI, followed by Gram-negative (G-), 40.3%, fungi, 10.9%, and mycobacteria, 4.2%. Candida spp. and coagulase-negative staphylococci were the most frequent pathogens found in nosocomial BSI (17% each), while E.coli was prevalent in community-acquired BSI (25%). At the last available follow-up, (mean 3.2 ± 2.7 years) the overall crude mortality was 40.5%. Factors associated with mortality in the final multivariate analysis were older age, (p = 0.02; HR 3.8, 95%CI 1.2-11.7) CDC stage C (p = 0.02; HR 3.3, 95%CI 1.2-9.1), malignancies, (p = 0.004; HR 3.2, 95%CI 1.4-7.0) and end stage liver disease (p = 0.006; HR 3.4, 95%CI 1.4-8.0). In conclusion, the study found high mortality following BSI in PLWHIV. Older age, neoplastic comorbidities, end stage liver disease and advanced HIV stage were the main factors correlated to mortality.
回顾性多中心研究旨在分析在现代抗逆转录病毒治疗时代，HIV 感染者（PLWHIV）血流感染（BSI）的病因、特征和结局。2008 年至 2015 年期间，79 名 PLWHIV 至少发生过 1 次 BSI，共分离出 119 种病原体。患者主要为男性（72.1%）、既往静脉吸毒者（55.7%）、合并 HCV 或 HBV 感染（58.2%）和 CDC 分期 C（60.8%）。革兰阳性（G+）病原体引起的 BSI 占 44.5%，其次是革兰阴性（G-）病原体，占 40.3%，真菌占 10.9%，分枝杆菌占 4.2%。医院获得性 BSI 中最常见的病原体是念珠菌属和凝固酶阴性葡萄球菌（各占 17%），而社区获得性 BSI 中则以大肠杆菌为主（占 25%）。在最后一次可获得的随访（平均 3.2±2.7 年）中，总粗死亡率为 40.5%。最终多变量分析中与死亡率相关的因素为年龄较大（p=0.02；HR 3.8，95%CI 1.2-11.7）、CDC 分期 C（p=0.02；HR 3.3，95%CI 1.2-9.1）、恶性肿瘤（p=0.004；HR 3.2，95%CI 1.4-7.0）和终末期肝病（p=0.006；HR 3.4，95%CI 1.4-8.0）。总之，本研究发现 PLWHIV 发生 BSI 后死亡率较高。年龄较大、合并恶性肿瘤、终末期肝病和 HIV 晚期是与死亡率相关的主要因素。
