Abstract
No data on antibiotic resistance in bloodstream infection (BSI) in people living with HIV (PLWH) exist. The objective of this study was to describe BSI epidemiology in PLWH focusing on multidrug resistant (MDR) organisms. A retrospective, single-center, observational study was conducted including all positive blood isolates in PLWH from 2004 to 2017. Univariable and multivariable GEE models using binomial distribution family were created to evaluate the association between MDR and mortality risk. In total, 263 episodes (299 isolates) from 164 patients were analyzed; 126 (48%) BSI were community-acquired, 137 (52%) hospital-acquired. At diagnosis, 34.7% of the patients had virological failure, median CD4 count was 207/μL. Thirty- and 90-day mortality rates were 24.2% and 32.4%, respectively. Thirty- and 90-day mortality rates for MDR isolates were 33.3% and 46.9%, respectively (p < 0.05). Enterobacteriaceae were the most prevalent microorganisms (29.8%), followed by Coagulase-negative staphylococci (21.4%), and S. aureus (12.7%). In BSI due to MDR organisms, carbapenem-resistant K. pneumoniae and methicillin-resistant S. aureus were associated with mortality after adjustment for age, although this correlation was not confirmed after further adjustment for CD4 < 200/μL. In conclusion, BSI in PLWH is still a major problem in the combination antiretroviral treatment era and it is related to a poor viro-immunological status, posing the question of whether it should be considered as an AIDS-defining event.
Highlights
HIV infection has various effects on cellular and humoral immunity, such as defective cell-mediated immunity and altered B-cell function
Of the 263 episodes, 218 (82.8%) were collected in the internal medicine wards, (8.4%) in intensive care unit (ICU), and (8.8%) in surgical wards; 72 (27.4%) bloodstream infection (BSI) originated from central indwelling catheters (CVC) (4/9 in ICU, 40%)
Epidemiology and antibiotic resistance profile can vary widely among different hospitals so it is very important to describe patterns of BSI in patients seen for care at our institution in order to prescribe empirical antibiotic treatment
Summary
HIV infection has various effects on cellular and humoral immunity, such as defective cell-mediated immunity and altered B-cell function. Qualitative and quantitative neutrophil deficits and skin and mucous membrane defects predispose persons living with HIV (PLWH) to develop bacterial infections more frequently than a HIV-seronegative patient [1]. Infections in this population could be severe, leading to prolonged hospitalization and mortality and to admittance in an intensive care unit (ICU) [2,3]. In the post combination antiretroviral treatment (cART) era, PLWH are more frequently admitted to ICU due to blood stream infections (BSIs) than to Pneumocystis jiroveci pneumonia [4]. Bacterial infections account for 15% of mortality causes among HIV patients in the United States [7]
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