Tumbarello M, Tacconelli E, Donati K G, Leone F, Morace G, Cauda R, Ortona L
Department of Infectious Diseases, Catholic University, Rome, Italy.
J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Dec 15;19(5):490-7. doi: 10.1097/00042560-199812150-00008.
A 3-year prospective matched case-control study was performed to investigate the potential risk factors, prognostic indicators, extension of hospital stay, and attributable mortality of nosocomial bloodstream infections in HIV-infected patients. Matching variables were: age, gender, number of circulating CD4+ T lymphocytes, cause of hospital admission, hospitalization in the same ward within the 6 weeks of diagnosis of the case, and length of stay before the day of infection in the case. Eighty-four cases and 168 matched controls were studied. Nosocomial bloodstream infections complicated about 3 of 1000 hospital days per patient in the study period. With step-wise logistic regression analysis, the most important predictors for developing nosocomial bloodstream infections were: increasing value of Acute Physiology and Chronic Health Evaluation (APACHE II) score (p = .001) and use of central venous catheter (CVC) (p = .002). The excess of hospital stay attributable to nosocomial bloodstream infections was 17 days. The crude mortality rate was 43%. The attributable mortality rate was estimated to be 27% (95% confidence interval [CI] = 13%-48%). The estimated risk ratio for death was 3.91 (95% CI = 2.06-7.44). Multivariate analysis identified two prognostic indicators that were significantly associated with unfavorable outcome of bloodstream infections: number of circulating CD4+ T cells <100/mm3 (p = .002) and APACHE II score >15 (p = .01). Nosocomial bloodstream infections are more common in patients with advanced HIV disease. Important cofactors are high APACHE II score and use of CVC. These infections can cause an excess mortality and significantly prolong the hospital stay of HIV-infected patients.
进行了一项为期3年的前瞻性配对病例对照研究，以调查HIV感染患者医院血流感染的潜在危险因素、预后指标、住院时间延长情况以及归因死亡率。配对变量包括：年龄、性别、循环CD4+T淋巴细胞数量、入院原因、病例诊断后6周内在同一病房住院情况以及病例感染当天前的住院时间。研究了84例病例和168例配对对照。在研究期间，每位患者每1000个住院日中约有3例发生医院血流感染。通过逐步逻辑回归分析，发生医院血流感染的最重要预测因素是：急性生理与慢性健康状况评估（APACHE II）评分升高（p = 0.001）和使用中心静脉导管（CVC）（p = 0.002）。医院血流感染导致的住院时间延长为17天。粗死亡率为43%。归因死亡率估计为27%（95%置信区间[CI] = 13%-48%）。估计死亡风险比为3.91（95%CI = 2.06-7.44）。多变量分析确定了两个与血流感染不良结局显著相关的预后指标：循环CD4+T细胞数量<100/mm3（p = 0.002）和APACHE II评分>15（p = 0.01）。医院血流感染在晚期HIV疾病患者中更常见。重要的辅助因素是高APACHE II评分和使用CVC。这些感染可导致额外的死亡率，并显著延长HIV感染患者的住院时间。
