Nosocomial infections in patients with HIV disease

Throughout the AIDS epidemic, nosocomial infection in the patient with HIV disease has presented a constant problem--not only for the hospitalized patient but also for the clinic attender. The nosocomial spread of multidrug-resistant tuberculosis has emphasized the need for effective control of infection measures in dealing with the immunodeficient. Increased recognition of nosocomial bacterial pneumonias has raised questions about the place, if any, of antimicrobial prophylaxis in preventing Gram-negative and Legionella infection. The use of long-term indwelling venous catheters for the administration of parenteral therapy is associated with an increased risk of nosocomial bloodstream infection--particularly from staphylococci and Pseudomonas spp. Evidence now exists for the nosocomial spread of opportunistic infections, including Cryptosporidium parvum, Mycobacterium avium complex and Pneumocystis carinii. The delay between exposure and diagnosis, the atypical presentation of infections such as tuberculosis and repeated hospital admissions of AIDS patients can combine to confuse the issue with the result that a nosocomial infection may be mis-classified as community-acquired. It seems likely that the burden of nosocomial infection in HIV disease is continually underestimated.