Lang Raynell, Gill M John, Vu Quang, Viczko Jeannine, Naugler Chris, Church Deirdre
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta, Canada.
Department of Pathology & Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta, Canada.
EClinicalMedicine. 2020 Dec 5;31:100675. doi: 10.1016/j.eclinm.2020.100675. eCollection 2021 Jan.
Staphylococcal blood stream infections (SBSI) are a significant cause of morbidity and mortality, however there is little data on such infections in persons with HIV (PWH) in the combination antiretroviral therapy era, particularly when divided by species; methicillin-sensitive (MSSA) and methicillin-resistant (MRSA) and coagulase-negative (CoNS).
Using linked longitudinal clinical and microbiologic databases, all cases of SBSI in PWH accessing care at Southern Alberta Clinic were identified and demographic features and outcomes characterized. We compared participants with SBSI to those with no SBSI and determined the 1-year all-cause mortality following SBSI and longitudinally over the study period.
From 2000 to 2018, 130 SBSI occurred in 95 PWH over 21,526 patient-years follow-up. MSSA caused 38.4%, MRSA 26.1% and CoNS 35.3% of SBSI. Highest risks for SSBI were in Hepatitis C coinfection, low CD4 nadir, Indigenous/Metis ethnicity and in persons who use injection drugs (PWID). During follow-up, 423 deaths occurred in all PWH. Mortality rates for PWH with SBSI was 74.9/1000 patient-years (95% CI 59.2-94.9) compared with no SBSI 16.0/1000 patient-years (95% CI 14.4-17.7). The mortality Hazard Ratio was 2.61(95% CI 1.95-3.49, = <0.001) for SBSI compared to no SBSI, following adjusting for confounding. Seventy deaths occurred in persons with SBSI with 40% in the first year. Higher 1-year mortality rates occurred in hospital-acquired infections.
Incidence rates of SBSI are high in PWH, with identified characteristics that further increase this risk. PWH who experience SBSI have a significant mortality risk within the first year of follow-up, however they also have greater long-term all-cause mortality compared to those with no SBSI. Further investigation is needed in PWH evaluating host, environment and pathogen differences that lead to differing rates of SBSI and mortality seen here.
No funding was received for this work.
葡萄球菌血流感染（SBSI）是发病和死亡的重要原因，然而在联合抗逆转录病毒治疗时代，关于人类免疫缺陷病毒感染者（PWH）此类感染的数据很少，尤其是按菌种分类的数据；甲氧西林敏感（MSSA）、耐甲氧西林（MRSA）和凝固酶阴性（CoNS）。
利用纵向关联的临床和微生物学数据库，确定了在艾伯塔省南部诊所接受治疗的PWH中所有SBSI病例，并对人口统计学特征和结局进行了描述。我们将患有SBSI的参与者与未患SBSI的参与者进行比较，并确定了SBSI后1年的全因死亡率以及研究期间的纵向死亡率。
从2000年到2018年，在21526患者年的随访中，95名PWH发生了130例SBSI。MSSA导致38.4%的SBSI，MRSA导致26.1%，CoNS导致35.3%。SSBI的最高风险发生在丙型肝炎合并感染、CD4最低点低、原住民/梅蒂斯族裔以及注射吸毒者（PWID）中。在随访期间，所有PWH中有423人死亡。患有SBSI的PWH的死亡率为74.9/1000患者年（95%CI 59.2-94.9），而未患SBSI的为16.0/1000患者年（95%CI 14.4-17.7）。在调整混杂因素后，与未患SBSI相比，SBSI的死亡风险比为2.61（95%CI 1.95-3.49，P<0.001）。SBSI患者中有70人死亡，其中40%在第一年。医院获得性感染的1年死亡率更高。
PWH中SBSI的发病率很高，具有一些进一步增加这种风险的特征。经历SBSI的PWH在随访的第一年内有显著的死亡风险，然而与未患SBSI的人相比，他们的长期全因死亡率也更高。需要对PWH进行进一步调查，以评估导致此处所见不同SBSI发病率和死亡率的宿主、环境和病原体差异。
这项工作未获得资助。
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