Pseudomonas spp. complications in patients with HIV disease:: An eight-year clinical and microbiological survey

被引:52
作者
Manfredi, R [1 ]
Nanetti, A [1 ]
Ferri, M [1 ]
Chiodo, F [1 ]
机构
[1] Univ Bologna, Dipartimento Med Clin Specialist & Sperimentale, Sez Malattie Infett, I-40138 Bologna, Italy
关键词
AIDS; diagnosis; HIV infection; Pseudomonas; risk factors; treatment;
D O I
10.1023/A:1007626410724
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Two hundred and twenty-four episodes of Pseudomonas spp. complications that occurred in 179 consecutive patients with HIV infection were retrospectively reviewed. Pseudomonas spp. organisms were responsible for 11.6% of 1933 episodes of non-mycobacterial bacterial diseases (5.4% of 1072 episodes of sepsis), observed over an 8-year period; 20.7% of patients experienced disease relapses (45 episodes). These complications mostly involved lower airways (66 cases), urinary tract (53 episodes), and blood (34 cases), with Pseudomonas aeruginosa isolated in 161 episodes, and other Pseudomonas spp. in the remaining 63 cases. An advanced HIV disease was frequently present (as expressed by a prior diagnosis of AIDS, a low CD4+ lymphocyte count, and leukopenia-neutropenia). Indwelling intravascular and urinary catheters were often associated with bacteremia and urinary tract involvement, respectively. More than 60% of patients were given antibiotics and/or cotrimoxazole in the month preceding the onset of Pseudomonas spp. disease. Bacterial strains isolated from our HIV-infected patients showed a favorable sensitivity to piperacillin, ceftazidime, imipenem, amikacin, tobramycin, and ciprofloxacin. An adequate antimicrobial treatment led to clinical and microbiological cure in 73.2% of patients at the first episode, and in 22.3% more subjects after one or more relapses. A lethal outcome occurred in only eight patients of 179 (4.5%), suffering from a far advanced HIV disease; P. aeruginosa infection directly contributed to death in four cases (sepsis, and/or pneumonia). Nosocomial disease occurred in 46.4% of the 224 episodes, and was significantly related to a previous diagnosis of AIDS, concurrent neutropenia, the occurrence of sepsis or urinary tract infection, disease relapses, the involvement of non-aeruginosa Pseudomonas spp., and a lethal outcome, compared with community-acquired infection. Our experience (the largest reported to date) confirms that Pseudomonas spp. (including non-aeruginosa Pseudomonas spp. organisms) is responsible for remarkable morbidity and mortality among patients with HIV infection, and may pose relevant problems to clinicians and microbiologists involved in the care of HIV-infected patients.
引用
收藏
页码:111 / 118
页数:8
相关论文
共 59 条
[1]   INVASIVE BACTERIAL-INFECTIONS IN CHILDREN BORN TO WOMEN INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1 [J].
ANDIMAN, WA ;
MEZGER, J ;
SHAPIRO, E .
JOURNAL OF PEDIATRICS, 1994, 124 (06) :846-852
[2]   PSEUDOMONAS-AERUGINOSA BRONCHOPULMONARY INFECTION IN LATE HUMAN-IMMUNODEFICIENCY-VIRUS DISEASE [J].
BARON, AD ;
HOLLANDER, H .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1993, 148 (04) :992-996
[3]  
BERGER BJ, 1994, INFECT DIS CLIN N AM, V8, P449
[4]  
Bernard E, 1996, PRESSE MED, V25, P746
[5]   Bloodstream infections in HIV-positive patients: A review of sixty-eight episodes [J].
Bonadio, M ;
Gigli, C ;
Maccanti, O ;
Longo, B ;
Smorfa, A .
JOURNAL OF CHEMOTHERAPY, 1998, 10 (03) :243-247
[6]   Bacterial infections in HIV: The extent and nature of the problem [J].
Brettle, RP .
INTERNATIONAL JOURNAL OF STD & AIDS, 1997, 8 (01) :5-15
[7]   MICROBIOLOGY OF COMMUNITY-ACQUIRED BACTERIAL PNEUMONIA IN PERSONS WITH AND AT RISK FOR HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1 INFECTION - IMPLICATIONS FOR RATIONAL EMPIRIC ANTIBIOTIC-THERAPY [J].
BURACK, JH ;
HAHN, JA ;
SAINTMAURICE, D ;
JACOBSON, MA .
ARCHIVES OF INTERNAL MEDICINE, 1994, 154 (22) :2589-2596
[8]   Estimation of the effect of neutropenia on rates of clinical bacteraemia in HIV-infected patients [J].
Caperna, J ;
Barber, RE ;
Toerner, JG ;
Mathews, WC .
EPIDEMIOLOGY AND INFECTION, 1998, 120 (01) :71-80
[9]   Nosocomial infections in human immunodeficiency virus-infected patients in a long-term-care setting [J].
DeMarais, PL ;
Gertzen, J ;
Weinstein, RA .
CLINICAL INFECTIOUS DISEASES, 1997, 25 (05) :1230-1232
[10]   Remission of relapsing Pseudomonas aeruginosa bronchopulmonary infection following antiretroviral therapy [J].
Domingo, P ;
Ferré, A ;
Baraldès, MA ;
Ris, J ;
Sánchez, F .
ARCHIVES OF INTERNAL MEDICINE, 1998, 158 (08) :929-930