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Pseudomonas infections in patients with AIDS and AIDS-related complex
F Franzetti1, M Cernuschi, R Esposito
1Clinic of Infectious Diseases, University of Milan, Italy.
Abstract:
We identified and reviewed retrospectively all the cases of infection by Pseudomonas and related genera in patients with AIDS and AIDS-related complex (ARC) who were hospitalized at our Institution over a 36-month period. We recorded 48 episodes of infection in 34 of 355 patients with AIDS, and in two of 73 patients with ARC: 25 pneumonias (9 community-acquired and 16 of nosocomial origin). 20 urinary tract infections, two soft tissue infections and one sepsis. In 14 of 16 patients with nosocomial pneumonia but in only one of nine patients with community-acquired pneumonia did we find coexisting opportunistic lung diseases. The following micro-organisms were isolated: P. aeruginosa in 41 cases, P. fluorescens in three cases, Xanthomonas maltophilia (P. maltophilia) in two cases, P. putida in one case. Comamonas testosteronis (P. testosteronis) and Comamonas acidovorans (P. acidovorans) in one case. Amikacin and ceftazidime, alone or in combination, appear to be the optimal choice of therapy for severe Pseudomonas infections in HIV-infected patients, although in our study six of 47 isolates were resistant in vitro to amikacin, and nine of 31 isolates were resistant to ceftazidime.
Insights
Pseudomonas infections are common in patients with Acquired Immunodeficiency Syndrome (AIDS). Amikacin and ceftazidime are effective treatments, but some Pseudomonas strains show resistance.
Area of Science:
- Infectious Diseases
- Microbiology
- Immunology
Background:
- Patients with Acquired Immunodeficiency Syndrome (AIDS) and AIDS-Related Complex (ARC) are susceptible to opportunistic infections.
- Pseudomonas and related genera are significant pathogens in immunocompromised individuals.
Purpose of the Study:
- To identify and review infections caused by Pseudomonas and related genera in hospitalized patients with AIDS/ARC.
- To determine the types of infections, causative organisms, and treatment outcomes.
Main Methods:
- Retrospective review of patient records over a 36-month period.
- Identification and isolation of bacterial pathogens.
- Analysis of infection types, patient demographics, and treatment efficacy.
Main Results:
- 48 episodes of infection were recorded in 34/355 AIDS patients and 2/73 ARC patients.
- Pneumonia (25 episodes) and urinary tract infections (20 episodes) were most common.
- Pseudomonas aeruginosa was the most frequently isolated organism (41 cases).
Conclusions:
- Amikacin and ceftazidime are recommended for severe Pseudomonas infections in HIV-infected patients.
- In vitro resistance to amikacin and ceftazidime was observed in a subset of isolates.
- Coexisting opportunistic lung diseases were more frequent in nosocomial pneumonia cases.