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1994-09-05
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Document 0834
DOCN M9480834
TI Pseudomonas aeruginosa bacteremia in HIV-infected patients.
DT 9410
AU Gilbert L; Peters B; Peoples D; Frederick W; Howard University Hospital,
Washington, DC.
SO Abstr Gen Meet Am Soc Microbiol. 1994;94:573 (abstract no. C-469).
Unique Identifier : AIDSLINE ASM94/94313111
AB In order to analyze epidemiological and clinical aspects of Pseudomonas
aeruginosa bacteremia (PAB) in HIV+ patients (pts), we conducted a
retrospective study of PAB during the period 1983-1993. Of the 281 pts
identified, 25 (20 males, 5 females) were HIV+. Their mean age was 34.5
years and 96% were black. HIV risk factors were IVDU (8),
homosexual/bisexual (13), heterosexual contact (3) and vertical
transmission (1). Fifteen pts had AIDS and 14 were taking zidovudine.
Intensive care unit (ICU) admissions were 8. Mean hospital stay for ICU
and ward admissions were 11.8 and 8.7 days respectively. All pts were
febrile, 9 had abnormal chest radiographs, and four grew PA from the
lung. Observed risk factors for PAB were neutropenia (< 500/mm3) (3),
intubation (1), central catheters (2), and shunts (3). T-helper (CD4+)
cell counts were below 200/mm3 in 13 pts and above in 9 pts. PAB was
nosocomial in 20 pts. No primary focus was identified in 11 pts. The
lung was the primary site in 9 pts. Eight pts had polymicrobial
bacteremia. Eleven (44%) pts received appropriate antimicrobial therapy.
Overall mortality was 80% with 35% of the deaths occurring within 24
hours of PAB. Mortality for ICU and ward admissions were 100% and 75%
respectively. Mortality for pts with CD4+ cell counts above and below
200/mm3 were 77% and 84% respectively. Among HIV+ pts, PAB carries a
high mortality and is unrelated to CD4+ counts. ICU admission did not
significantly alter PAB mortality rates. Clinicians need to be aware of
this high mortality rate and that PAB occur commonly in HIV+ pts without
identifiable primary foci and predisposing factors. Thus a high index of
suspicion is needed so that appropriate therapy can be instituted
earlier.
DE Acquired Immunodeficiency Syndrome/*COMPLICATIONS/DRUG THERAPY Adult
AIDS-Related Opportunistic Infections/DRUG THERAPY/*EPIDEMIOLOGY/
MORTALITY Bacteremia/DRUG THERAPY/*EPIDEMIOLOGY/MORTALITY Comparative
Study Female Hospital Units Human HIV Infections/*COMPLICATIONS/DRUG
THERAPY Intensive Care Units Male *Pseudomonas aeruginosa
Pseudomonas Infections/DRUG THERAPY/*EPIDEMIOLOGY/MORTALITY
Retrospective Studies Risk Factors Sex Behavior Survival Rate
Zidovudine/THERAPEUTIC USE MEETING ABSTRACT
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).