Pseudomonas aeruginosa bacteremia in HIV-infected patients.

Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.

Pseudomonas aeruginosa bacteremia in HIV-infected patients.

Abstr Gen Meet Am Soc Microbiol. 1994;94:573 (abstract no. C-469). Unique Identifier : AIDSLINE ASM94/94313111
Gilbert L; Peters B; Peoples D; Frederick W; Howard University Hospital, Washington, DC.

Abstract: In order to analyze epidemiological and clinical aspects of Pseudomonas aeruginosa bacteremia (PAB) in HIV+ patients (pts), we conducted a retrospective study of PAB during the period 1983-1993. Of the 281 pts identified, 25 (20 males, 5 females) were HIV+. Their mean age was 34.5 years and 96% were black. HIV risk factors were IVDU (8), homosexual/bisexual (13), heterosexual contact (3) and vertical transmission (1). Fifteen pts had AIDS and 14 were taking zidovudine. Intensive care unit (ICU) admissions were 8. Mean hospital stay for ICU and ward admissions were 11.8 and 8.7 days respectively. All pts were febrile, 9 had abnormal chest radiographs, and four grew PA from the lung. Observed risk factors for PAB were neutropenia (< 500/mm3) (3), intubation (1), central catheters (2), and shunts (3). T-helper (CD4+) cell counts were below 200/mm3 in 13 pts and above in 9 pts. PAB was nosocomial in 20 pts. No primary focus was identified in 11 pts. The lung was the primary site in 9 pts. Eight pts had polymicrobial bacteremia. Eleven (44%) pts received appropriate antimicrobial therapy. Overall mortality was 80% with 35% of the deaths occurring within 24 hours of PAB. Mortality for ICU and ward admissions were 100% and 75% respectively. Mortality for pts with CD4+ cell counts above and below 200/mm3 were 77% and 84% respectively. Among HIV+ pts, PAB carries a high mortality and is unrelated to CD4+ counts. ICU admission did not significantly alter PAB mortality rates. Clinicians need to be aware of this high mortality rate and that PAB occur commonly in HIV+ pts without identifiable primary foci and predisposing factors. Thus a high index of suspicion is needed so that appropriate therapy can be instituted earlier.

Keywords: Acquired Immunodeficiency Syndrome/*COMPLICATIONS/DRUG THERAPY Adult AIDS-Related Opportunistic Infections/DRUG THERAPY/*EPIDEMIOLOGY/ MORTALITY Bacteremia/DRUG THERAPY/*EPIDEMIOLOGY/MORTALITY Comparative Study Female Hospital Units Human HIV Infections/*COMPLICATIONS/DRUG THERAPY Intensive Care Units Male *Pseudomonas aeruginosa Pseudomonas Infections/DRUG THERAPY/*EPIDEMIOLOGY/MORTALITY Retrospective Studies Risk Factors Sex Behavior Survival Rate Zidovudine/THERAPEUTIC USE ABSTRACT
941030
M94A0843

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