Community-acquired bacteremia in patients with acquired immunodeficiency syndrome: clinical presentation,...

Community-acquired bacteremia is an easily treatable infection occurring in patients with acquired immunodeficiency syndrome (AIDS). Although other studies have reported bacterial infections in AIDS patients, none have clearly described the clinical presentation of these patients. In this survey, we sought to define how frequently AIDS patients presented to our institution with community-acquired bacteremia; which organisms and sources of bacteremia were involved; the frequency that these patients presented with abnormal vital signs and white blood cell counts; and the in-hospital outcome of these patients.

We retrospectively identified patients with AIDS hospitalized at San Francisco General Hospital in the 16 months between August 1986 and December 1987 in whom a positive blood culture was drawn within 24 hours of admission. Each of the patient's charts was reviewed for demographic data, relevant past medical history, clinical admission information, laboratory data, and discharge status.

We identified 44 episodes of community-acquired bacteremia in 38 patients with AIDS. These episodes represented approximately 5% of the admissions of patients with AIDS. The patients were young (mean age, 38 +/- 7 years), homosexual (43 of 44), and in some cases intravenous drug users (nine of 44). On admission, only 57% of the patients were febrile (temperature greater than 38.3 degrees C) and 23% of the patients presented with normal vital signs. Twenty-seven percent were neutropenic (less than 1,000 neutrophils/mm3). The most common sources of the bacteremia were pneumonia (10), an indwelling central venous line (eight), and cellulitis (seven). A total of 14 patients had no apparent source. Staphylococcus aureus, Streptococcus pneumoniae, and Escherichia coli were the most common organisms. Only four of the 44 patients died during their hospitalization.

We conclude that patients with AIDS and community-acquired bacteremia can present to the hospital without abnormal vital signs or white blood cell counts. Clinicians cannot depend on these data to assist them in excluding the possibility of bacteremia in patients with AIDS. In addition, due to the variety of organisms found in our survey, we recommend that broad-spectrum antibiotics should be the empiric therapy in patients with a suspected bacterial infection.