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Serious Pseudomonas aeruginosa infection in AIDS
D H Shepp1, I T Tang, M B Ramundo
1Department of Medicine, North Shore University Hospital-Cornell, University Medical College, Manhasset, New York 11030.
Abstract:
During a 7-year period, 32 patients with Pseudomonas aeruginosa infection were identified on an HIV treatment service at a university-affiliated teaching hospital. The number of cases increased from 2 in 1986 to 13 in 1992. Affected patients had evidence of advanced HIV infection. In those treated with antiretroviral therapy, 96% of infections occurred > 1 year after initial presentation with HIV disease. Eighteen cases of pneumonia and 14 nonpulmonary (central venous access device, soft tissue, middle ear-mastoid, corneal, and peritoneal) infections were seen. Comparison with matched controls identified use of a central venous access device and administration of aerosolized pentamidine, corticosteroids, or ganciclovir as risk factors for infection (odds ratios, 5.3, 6.5, 15.0, and 9.0, respectively; p = 0.004, 0.007, 0.02, and 0.02, respectively). Seventy-five percent of cases had community onset, but time since last hospital discharge was significantly shorter in study patients than in controls (mean difference, -85 days; 95% confidence interval, -24 to -146; p = 0.01). Among evaluable cases, outcome was fatal (survival < or = 30 days) in 2 of 16 (13%) patients in whom initial antibiotic therapy was appropriate and 8 of 14 (57%) patients in whom initial therapy was not appropriate (p = 0.016). Ten recurrent infections were seen in 8 of 21 patients who survived the initial infection. Median survival after onset of infection was only 80 days. Pseudomonas aeruginosa infection is an increasingly frequent, severe complication of advanced HIV disease. Several treatment and prevention strategies used in the management of advanced HIV disease are associated with an increased risk of infection.
Insights
Pseudomonas aeruginosa infections are a growing concern in advanced HIV disease patients. Risk factors include central venous access devices and certain HIV treatments, with inappropriate initial antibiotic therapy increasing fatality.
Area of Science:
- Infectious Diseases
- Immunology
- Public Health
Background:
- * Pseudomonas aeruginosa infections pose a significant threat to individuals with advanced Human Immunodeficiency Virus (HIV) disease.
- * A notable increase in cases was observed over a 7-year period at a university-affiliated hospital.
- * These infections are often associated with severe immunodeficiency and specific medical interventions.
Purpose of the Study:
- * To investigate the incidence, risk factors, and outcomes of Pseudomonas aeruginosa infections in patients with advanced HIV.
- * To identify associations between specific treatments for advanced HIV and the development of these infections.
- * To evaluate the impact of initial antibiotic therapy on patient survival.
Main Methods:
- * Retrospective analysis of 32 patients with Pseudomonas aeruginosa infection over a 7-year period.
- * Comparison with matched controls to identify risk factors.
- * Analysis of treatment strategies, onset of infection, and patient outcomes, including survival rates.
Main Results:
- * Infections increased from 2 in 1986 to 13 in 1992, primarily in patients with advanced HIV.
- * Identified risk factors include central venous access devices and treatments like aerosolized pentamidine, corticosteroids, and ganciclovir.
- * Inappropriate initial antibiotic therapy was linked to significantly higher mortality (57% vs. 13%) and shorter median survival (80 days).
Conclusions:
- * Pseudomonas aeruginosa infection is an increasingly frequent and severe complication of advanced HIV disease.
- * Certain management strategies for advanced HIV are associated with an elevated risk of infection.
- * Timely and appropriate antibiotic therapy is crucial for improving survival outcomes in these patients.