Acquisition of resistant microorganisms and infections in HIV-infected patients admitted to the ICU
N Cobos-Trigueros1, M Rinaudo, M Solé
1Department of Infectious Diseases, Hospital Clínic-IDIBAPS-Barcelona Centre for International Health Research (CRESIB), Barcelona University, Villarroel 170, 08036, Barcelona, Spain, fncobos@clinic.ub.es.
Abstract:
Whether critically ill human immunodeficiency virus (HIV)-infected patients are at risk of acquiring nosocomial infections and resistant or potentially resistant microorganisms (RPRMs) remains to be clarified. The aim was to compare the acquisition of RPRMs, infections and mortality in critically ill HIV-infected and non-infected patients. An observational, prospective cohort study of patients admitted to a medical intensive care unit (ICU) was undertaken. Swabbing of nares, pharynx and rectum, and culture of respiratory secretions were obtained within 48 h of admission and thrice weekly thereafter. Clinical samples were obtained as deemed necessary by the attending physician. Clinical variables, severity scores on admission and exposures during ICU stay were collected. Logistic regression was used to evaluate ICU mortality. Out of the 969 included patients, 64 (6.6%) were HIV-infected. These patients had a higher Acute Physiology and Chronic Health Evaluation (APACHE) II score on admission (19.5 ± 6.6 vs. 21.1 ± 5.4, p = 0.02), stayed longer in the care unit and were more exposed to several invasive devices and antibiotics. There were no differences in the rate of acquisition of RPRMs and the only difference in ICU-acquired infections was a significantly higher incidence of catheter-related bacteraemia (3% vs. 9%, p = 0.03). The ICU-related mortality was similar in both groups (14% vs. 16%, p = 0.70) and in HIV-infected patients, it tended to be associated with a lower CD4 cell count (p = 0.06). Despite a longer ICU stay, critically ill HIV-infected patients did not show a higher rate of RPRMs acquisition. The rate of ICU-acquired infection was similar between HIV-infected and non-infected patients, except for catheter-related bacteraemia, which was higher in the HIV-infected population. Mortality was similar in both groups.
Insights
Critically ill patients with human immunodeficiency virus (HIV) infection did not acquire resistant microorganisms more frequently. However, HIV-infected patients had higher rates of catheter-related bloodstream infections in the intensive care unit (ICU).
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Immunology
Background:
- The risk of nosocomial infections and resistant microorganisms in critically ill human immunodeficiency virus (HIV)-infected patients is not well-defined.
- Understanding these risks is crucial for optimizing care in intensive care units (ICUs).
Purpose of the Study:
- To compare the acquisition of resistant or potentially resistant microorganisms (RPRMs) between critically ill HIV-infected and non-infected patients.
- To evaluate differences in intensive care unit (ICU)-acquired infections and mortality between these two patient groups.
Main Methods:
- An observational, prospective cohort study was conducted in a medical ICU.
- Microbiological samples (nares, pharynx, rectum swabs, respiratory secretions) were collected from 969 patients (64 HIV-infected) upon admission and regularly thereafter.
- Clinical data, severity scores (APACHE II), and exposures were collected; logistic regression analyzed ICU mortality.
Main Results:
- HIV-infected patients had higher APACHE II scores and longer ICU stays, with increased exposure to invasive devices and antibiotics.
- No significant difference was observed in the acquisition rate of RPRMs between HIV-infected and non-infected patients.
- A higher incidence of catheter-related bacteraemia (9% vs. 3%) was noted in HIV-infected patients; overall ICU-acquired infection rates were similar.
Conclusions:
- Critically ill HIV-infected patients do not exhibit an increased risk of acquiring RPRMs despite longer ICU stays and higher device utilization.
- While overall ICU-acquired infection rates are comparable, HIV-infected patients face a higher risk of catheter-related bacteraemia.
- ICU mortality rates were similar between groups, though lower CD4 counts trended with increased mortality in HIV-infected patients.
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