Chin D P, Reingold A L, Stone E N, Vittinghoff E, Horsburgh C R, Simon E M, Yajko D M, Hadley W K, Ostroff S M, Hopewell P C
Medical Service, San Francisco General Hospital Medical Center, Georgia.
J Infect Dis. 1994 Sep;170(3):578-84. doi: 10.1093/infdis/170.3.578.
It is currently recommended that patients with AIDS and Mycobacterium avium complex (MAC) bacteremia receive antimycobacterial treatment. However, no study has prospectively evaluated the impact of this infection and its treatment on survival. This study prospectively followed a cohort of 367 AIDS patients with < or = 50 CD4+ cells/microL and found that MAC bacteremia was independently associated with an increased risk of death (relative hazard [RH] = 1.8, 95% confidence interval [CI] = 1.3-2.4, P < .001). Patients with MAC bacteremia who were treated had a longer median survival than those who were not (263 vs. 139 days, P < .001); treatment was independently associated with a lower risk of death (RH = 0.45, 95% CI = 0.23-0.89, P < .001). However, 23% of patients with bacteremia died within 28 days of that diagnosis; few were treated. MAC bacteremia contributes to the death of patients with AIDS, and treatment increases survival. However, many patients will not survive long enough to receive treatment. These results underscore the importance of early diagnosis and chemoprophylaxis for MAC bacteremia.
目前建议艾滋病合并鸟分枝杆菌复合体（MAC）菌血症患者接受抗分枝杆菌治疗。然而，尚无研究前瞻性评估这种感染及其治疗对生存的影响。本研究前瞻性随访了367例CD4 +细胞/微升≤50的艾滋病患者队列，发现MAC菌血症与死亡风险增加独立相关（相对风险[RH]=1.8，95%置信区间[CI]=1.3 - 2.4，P<.001）。接受治疗的MAC菌血症患者的中位生存期长于未接受治疗的患者（263天对139天，P<.001）；治疗与较低的死亡风险独立相关（RH = 0.45，95% CI = 0.23 - 0.89，P<.001）。然而，23%的菌血症患者在诊断后28天内死亡；很少有人接受治疗。MAC菌血症导致艾滋病患者死亡，治疗可提高生存率。然而，许多患者存活时间不足以接受治疗。这些结果强调了对MAC菌血症进行早期诊断和化学预防的重要性。
