Puerta-Alcalde Pedro, Ambrosioni Juan, Chumbita Mariana, Hernández-Meneses Marta, Garcia-Pouton Nicole, Cardozo Celia, Moreno-García Estela, Marco Francesc, Mensa Josep, Rovira Montserrat, Esteve Jordi, Martínez Jose A, García Felipe, Mallolas Josep, Soriano Alex, Miró José M, Garcia-Vidal Carolina
Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain.
Microbiology Department, Centre Diagnòstic Biomèdic, Hospital Clinic, Barcelona, Spain.
Infect Dis Ther. 2021 Jun;10(2):955-970. doi: 10.1007/s40121-021-00445-3. Epub 2021 Apr 11.
We aimed to compare the clinical characteristics and outcomes of bloodstream infections (BSI) in cancer patients presenting febrile neutropenia with and without HIV infection, and analyze the prognostic factors for mortality.
BSI episodes in febrile neutropenic patients following chemotherapy were prospectively collected (1997-2018). A case (HIV-infected)-control (non-HIV-infected) sub-analysis was performed (1:2 ratio), matching patients by age, gender, baseline disease, and etiological microorganism.
From 1755 BSI episodes in neutropenic cancer patients, 60 (3.4%) occurred in those with HIV. HIV characteristics: 51.7% were men who have sex with men; 58.3% had < 200 CD4; 51.7% had a detectable HIV-1 RNA viral load before the BSI episode; 70.0% met AIDS-defining criteria; and 93.3% were on antiretroviral therapy, with a protease inhibitor-based regimen being the most common (53.0%). HIV-infected patients were younger, more frequently male and more commonly presenting chronic liver disease (p < 0.001 for all). BSI due to Enterococcus spp. was significantly more frequent among patients with HIV (p = 0.017) with no differences in other pathogens. HIV-infected patients with cancer presented with shock more frequently (p = 0.014) and had higher mortality (31.7% vs. 18.1%, p = 0.008). In the case-control analysis, cases (HIV-infected) had chronic liver disease (p = 0.003) more frequently, whereas acute leukemia (p = 0.013) and hematopoietic stem-cell transplant (p = 0.023) were more common among controls. There was a non-significant trend for cases to have higher mortality (p = 0.084). However, in multivariate analysis, HIV infection was not associated with mortality (p = 0.196).
HIV-infected patients with cancer developing febrile neutropenia and BSI have different epidemiological and clinical profiles, and experience higher mortality. However, HIV infection by itself was not associated with mortality.
我们旨在比较发热性中性粒细胞减少的癌症患者中合并和未合并HIV感染的血流感染（BSI）的临床特征及转归，并分析死亡的预后因素。
前瞻性收集化疗后发热性中性粒细胞减少患者的BSI发作情况（1997 - 2018年）。进行病例（HIV感染）-对照（非HIV感染）亚组分析（1:2比例），根据年龄、性别、基线疾病和病原微生物对患者进行匹配。
在中性粒细胞减少的癌症患者的1755次BSI发作中，60次（3.4%）发生在HIV感染者中。HIV特征：51.7%为男男性行为者；58.3%的CD4细胞计数<200；51.7%在BSI发作前可检测到HIV-1 RNA病毒载量；70.0%符合艾滋病定义标准；93.3%接受抗逆转录病毒治疗，以蛋白酶抑制剂为基础的方案最为常见（53.0%）。HIV感染患者更年轻，男性更常见，更常合并慢性肝病（所有p<0.001）。HIV感染者中肠球菌属导致的BSI明显更常见（p = 0.017），其他病原体无差异。合并癌症的HIV感染患者更常出现休克（p = 0.014）且死亡率更高（31.7%对18.1%，p = 0.008）。在病例对照分析中，病例组（HIV感染）更常合并慢性肝病（p = 0.003），而对照组中急性白血病（p = 0.013）和造血干细胞移植（p = 0.023）更常见。病例组有更高死亡率的趋势但无统计学意义（p = 0.084）。然而，在多变量分析中，HIV感染与死亡率无关（p = 0.196）。
合并癌症且发生发热性中性粒细胞减少和BSI的HIV感染患者具有不同的流行病学和临床特征，且死亡率更高。然而，HIV感染本身与死亡率无关。
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