Community-acquired bacterial pneumonia in human immunodeficiency virus-infected patients -: Validation of severity criteria

被引:50
作者
Cordero, E
Pachón, J
Rivero, A
Girón, JA
Gómez-Mateos, J
Merino, MD
Torres-Tortosa, M
González-Serrano, M
Aliaga, L
Collado, A
Hernández-Quero, J
Barrera, A
Nuño, E
机构
[1] Hosp Univ Virgen del Rocio, Infect Dis Serv, Seville 41013, Spain
[2] Valme Univ Hosp, Infect Dis Serv, Seville, Spain
[3] Virgen de la Victoria Univ Hosp, Infect Dis Serv, Malaga, Spain
[4] Axarquia Clin Hosp, Infect Dis Serv, Malaga, Spain
[5] Puerta del Mar Univ Hosp, Infect Dis Serv, Cadiz, Spain
[6] Punta de Europa Hosp, Infect Dis Serv, Algeciras, Spain
[7] La Linea de la Concepcion SAS Hosp, Infect Dis Serv, Cadiz, Spain
[8] Jerez de la Frontera SAS Hosp, Infect Dis Serv, Cadiz, Spain
[9] Juan Ramon Jimenez Hosp, Infect Dis Serv, Huelva, Spain
[10] Virgen de las Nieves Univ Hosp, Infect Dis Serv, Granada, Spain
[11] Granada Clin Hosp, Infect Dis Serv, Granada, Spain
[12] Torrecardenas Hosp, Almeria, Spain
关键词
D O I
10.1164/ajrccm.162.6.9910104
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Severity criteria for community-acquired pneumonia (CAP) have always excluded patients with human immunodeficiency virus (HIV) infection. A 1-yr, multicenter, prospective observational study of HIV-infected patients with bacterial CAP was done to validate the criteria used in the American Thoracic: Society (ATS) guidelines for CAP, and to determine the prognosis-associated factors in the HIV-infected population with bacterial CAP. Overall, 355 cases were included, with an attributable mortality of 9.3%. Patients who met the ATS criteria had a longer hospital stay (p = 0.01), longer duration of fever (p < 0.001), and higher attributable mortality (13.1% versus 3.5%, p = 0.02) than those who did not. Three factors were independently related to mortality: CD4(+) cell count < 100/mul, radiologic progression of disease, and shock. Pleural effusion, cavities, and/or multilobar infiltrates at admission were independently associated with radiologic progression. A prognostic rule based on the five criteria of shock, CD4(+) cell count < 100/<mu>l, pleural effusion, cavities, and multilobar infiltrates had a high negative predictive value for mortality (97.1%). The attributable mortality for severe pneumonia was 11.3%, as compared with 1.3% for nonsevere disease (p = 0.008). The ATS severity criteria are valid in HIV-infected patients with bacterial CAP. Our study provides the basis for identification of patients who may require hospitalization determined by clinical judgment and the-five clinical criteria of shock, a CD4(+) cell count < 100/<mu>l, pleural effusion, cavities, and multilobar involvement. These prognostic factors should be validated in independent cohort studies.
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收藏
页码:2063 / 2068
页数:6
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