Characteristics of Drug-Susceptible and Drug-Resistant Staphylococcus aureus Pneumonia in Patients with HIV

Laurence Huang

doi:10.4172/2161-1165.1000122

Abstract

ObjectivesTo examine predictors and outcomes of Staphylococcus aureus Pneumonia (SAP) in people with HIV compared with Streptococcus pneumoniae Pneumonia (SPP), and to compare Methicillin-Resistant S. aureus (MRSA) with Methicillin-Sensitive S. aureus (MSSA) pneumonias in this population.MethodsWe conducted a retrospective case-control study of HIV-infected patients admitted to a single center with culture-proven S. aureus or S. pneumoniae pneumonia. We identified patients through a computerized database, conducted structured chart reviews, and performed bivariate and multivariate analyses using logistic regression.ResultsWe compared 47 SAP episodes in 42 patients with 100 SPP episodes in 93 patients. Use of any antibiotics prior to admission (OR=3.5, p=0.02), a co-morbid illness (OR=4.2, p=0.04), and recent healthcare contact (OR=12.0, p<0.001) were significant independent predictors of SAP. Patients with SAP were more likely to require intensive care (OR=2.7, p=0.02) and mechanical ventilation (OR=3.1, p=0.02), but not to die. MRSA was more common (57% of cases) than MSSA, but outcomes were not significantly worse.ConclusionsPatients with HIV and SAP have worse outcomes than those with SPP. Clinicians should consider empiric antibiotic coverage for MRSA in patients admitted with HIV and pneumonia, given the high prevalence of MRSA. Further studies are warranted to examine morbidity differences between HIV-associated MSSA and MRSA pneumonia.

Highlights

Bacterial pneumonia is a well-recognized complication of HIV infection
Clinicians should consider empiric antibiotic coverage for Methicillin-Resistant S. aureus (MRSA) in patients admitted with HIV and pneumonia, given the high prevalence of MRSA
To better characterize Community-Acquired Pneumonia (CAP) due to S. aureus in patients with HIV, we reviewed all cases of Staphylococcus aureus Pneumonia (SAP) over a 13-year period at our institution

Summary

Introduction

The risk for HIVassociated bacterial pneumonia increases with declining CD4 cell counts and persists despite decreased opportunistic complications and improved survival due to Antiretroviral Therapy (ART) [1, 2]. Despite widespread access to ART, bacterial Community-Acquired Pneumonia (CAP) remains the most common pulmonary complication of HIV disease, with a 5-fold greater incidence in people with HIV [3]. Streptococcus pneumoniae is the most commonly isolated pathogen in patients with HIV and CAP [1, 8, 9]. Many of the studies that established the risk factors for CAP and its outcomes in people with HIV focused on invasive pneumococcal disease, while others did not clearly establish microbiological etiology but must have included large numbers of patients with pneumococcus [7,8,9,10]

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