Bloodstream infections among human immunodeficiency virus-infected adult patients:: epidemiology and risk factors for mortality
Bloodstream infections among human immunodeficiency virus-infected adult patients:: epidemiology and risk factors for mortality
复制标题
DOI：
10.1007/s10096-008-0531-5
复制
发表时间：
2008-10-01
影响因子：
4.5
通讯作者：
Mensa, J.
中科院分区：
文献类型：
--
作者：
Ortega, M.;Almela, M.;Mensa, J.
本研究旨在描述引起成人HIV感染患者社区获得性（CA）和医院获得性（N）血流感染（BSI）的病原体的流行病学和敏感性模式，并建立死亡率的危险因素。研究类型为回顾性分析1991年1月至2006年12月通过血培养监测项目前瞻性收集的BSI事件。我们使用非条件Logistic回归方法，以死亡作为因变量。在研究期间，在16，946次BSI发作中，有1，077次（6%）发生在HIV感染患者中。CA和NBSI分别为634例（59%）和443例（41%）。S.肺炎链球菌和S.金黄色葡萄球菌是CA BSI中最常见的病原体（n=279，44%）。凝固酶阴性葡萄球菌和S.金黄色葡萄球菌是N例（n=169，38%）中最常见的微生物。复方新诺明耐药在CA和NBSI中常见，由革兰阴性杆菌引起（分别为50%和61%）。然而，对头孢曲松的耐药率较低（3%）。粗死亡率为140例（13%）。与死亡率相关的独立危险因素为：肝硬化（OR：2.90，p=0.001）、糖皮质激素治疗（OR：3.51，p < 0.001）、中性粒细胞减少（OR：2.21，p=0.02）、经验性治疗不当（OR：2.44，p=0.006）和分离念珠菌。白色念珠菌（OR：7.58，p =0.010）。在CA和N环境中，成人HIV感染患者的BSI通常由革兰氏阳性病原体引起。不适当的经验性治疗和其他免疫抑制因素的存在是死亡率的独立危险因素。头孢曲松可作为HIV感染疑似CA BSI患者的初始经验性治疗。
This study was undertaken to describe the epidemiology and sensitivity pattern of pathogens causing community-acquired (CA) and nosocomial (N) bloodstream infection (BSI) in adult HIV-infected patients and to establish risk factors for mortality. The type of study was a retrospective analysis of BSI episodes prospectively collected through a blood culture surveillance program from January 1991 to December 2006. We used non-conditional logistic regression methods with death as a dependent variable. One thousand and seventy-seven episodes of BSI (6%) occurred in HIV-infected patients out of 16,946 episodes during the period of study. CA and N BSI were 634 (59%) and 443 (41%) respectively. S. pneumoniae and S. aureus were the most frequent pathogens (n=279, 44%) in CA BSI. Coagulase-negative staphylococci and S. aureus were the most frequent micro-organisms isolated in N cases (n=169, 38%). Cotrimoxazole resistance was common in CA and N BSI and was caused by gram-negative bacilli (50% and 61% respectively). However, resistance rates to ceftriaxone were low (3%). Crude mortality accounted for 140 cases (13%). The independent risk factors associated with mortality were: liver cirrhosis (OR: 2.90, p=0.001), corticosteroids treatment (OR: 3.51, p < 0.001), neutropenia (OR: 2.21, p=0.02), inappropriate empirical therapy (OR: 2.44, p=0.006), and isolate of C. albicans (OR: 7.58, p=0.010). BSI in adult HIV-infected patients was often caused by gram-positive pathogens in both CA and N settings. Inappropriate empirical therapy and the presence of other immunosuppressive factors were independent risk factors for mortality. Ceftriaxone could be used as the initial empiric therapy for HIV-infected patients with suspected CA BSI.