Mortality predictive factors of people living with human immunodeficiency virus and bloodstream infection
Introduction: Portugal has one of the highest mortality rates for people living with HIV (PLWHIV) in Europe. After antiretroviral therapy introduction, HIV-associated mortality declined, included the one associated with bloodstream infection (BSI). However it is still high, and European data are sca...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-09-01
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| Series: | International Journal of Infectious Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971221005221 |
| _version_ | 1818358877963419648 |
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| author | Andreia De Matos Sara Brandão Lopes José Eduardo Serra Eugénia Ferreira José Saraiva da Cunha |
| author_facet | Andreia De Matos Sara Brandão Lopes José Eduardo Serra Eugénia Ferreira José Saraiva da Cunha |
| author_sort | Andreia De Matos |
| collection | DOAJ |
| description | Introduction: Portugal has one of the highest mortality rates for people living with HIV (PLWHIV) in Europe. After antiretroviral therapy introduction, HIV-associated mortality declined, included the one associated with bloodstream infection (BSI). However it is still high, and European data are scarce . Therefore, characterizing BSI and defining prognostic factors may improve our approach. Methods: This was a 10-year retrospective study of predictive factors for 30-day and 3-year mortality in PLWHIV with BSI in a tertiary infectious diseases ward. Results: Of 2134 PLWHIV admissions, 145 (6.8%) had a BSI, mostly respiratory and catheter-related bacteremia and globally community-acquired. Nosocomial infections occurred in 42 (36%) cases, mostly caused by Enterococcus spp, Staphylococcus aureus, and Candida spp. PLWHIV with a BSI had higher 30-day mortality (27%) compared to those without a BSI (14%). APACHE II score, corticotherapy, and current intravenous drug use (IDU) had a prognostic impact on 30-day mortality. Three-year survival was 54% in PLWHIV with a BSI; a CD4 <200 cells, vascular or chronic pulmonary disease, and lymphoma were prognostic factors. Conclusions: Patients with a BSI were more likely to present advanced HIV disease, have more comorbidities, a longer length of stay, and higher 30-day mortality. IDU and severity of infection determined the short-term prognosis. Three-year mortality was primarily influenced by lower CD4 cell counts, hematological tumor, and cardiopulmonary comorbidities. Systemic corticotherapy may influence nosocomial BSI and short-term prognosis. |
| first_indexed | 2024-12-13T20:35:59Z |
| format | Article |
| id | doaj.art-46d21b1b60d94c97a2b1ebd413eb8a2d |
| institution | Directory Open Access Journal |
| issn | 1201-9712 |
| language | English |
| last_indexed | 2024-12-13T20:35:59Z |
| publishDate | 2021-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-46d21b1b60d94c97a2b1ebd413eb8a2d2022-12-21T23:32:18ZengElsevierInternational Journal of Infectious Diseases1201-97122021-09-01110195203Mortality predictive factors of people living with human immunodeficiency virus and bloodstream infectionAndreia De Matos0Sara Brandão Lopes1José Eduardo Serra2Eugénia Ferreira3José Saraiva da Cunha4Internal Medicine Department, Coimbra Hospital and University Center, Coimbra, Portugal; Corresponding author: Andreia Margarida Carvalho de Matos, Internal Medicine Department, Coimbra Hospital and University Center, Praceta Rua Professor Mota Pinto, 3004-561 Coimbra, Portugal.Infectious Disease Department, Coimbra Hospital and University Center, Coimbra, PortugalInfectious Disease Department, Coimbra Hospital and University Center, Coimbra, PortugalInfectious Disease Department, Coimbra Hospital and University Center, Coimbra, PortugalInfectious Disease Department, Coimbra Hospital and University Center, Coimbra, PortugalIntroduction: Portugal has one of the highest mortality rates for people living with HIV (PLWHIV) in Europe. After antiretroviral therapy introduction, HIV-associated mortality declined, included the one associated with bloodstream infection (BSI). However it is still high, and European data are scarce . Therefore, characterizing BSI and defining prognostic factors may improve our approach. Methods: This was a 10-year retrospective study of predictive factors for 30-day and 3-year mortality in PLWHIV with BSI in a tertiary infectious diseases ward. Results: Of 2134 PLWHIV admissions, 145 (6.8%) had a BSI, mostly respiratory and catheter-related bacteremia and globally community-acquired. Nosocomial infections occurred in 42 (36%) cases, mostly caused by Enterococcus spp, Staphylococcus aureus, and Candida spp. PLWHIV with a BSI had higher 30-day mortality (27%) compared to those without a BSI (14%). APACHE II score, corticotherapy, and current intravenous drug use (IDU) had a prognostic impact on 30-day mortality. Three-year survival was 54% in PLWHIV with a BSI; a CD4 <200 cells, vascular or chronic pulmonary disease, and lymphoma were prognostic factors. Conclusions: Patients with a BSI were more likely to present advanced HIV disease, have more comorbidities, a longer length of stay, and higher 30-day mortality. IDU and severity of infection determined the short-term prognosis. Three-year mortality was primarily influenced by lower CD4 cell counts, hematological tumor, and cardiopulmonary comorbidities. Systemic corticotherapy may influence nosocomial BSI and short-term prognosis.http://www.sciencedirect.com/science/article/pii/S1201971221005221Bloodstream infectionHuman immunodeficiency virus patientsMortality predictors |
| spellingShingle | Andreia De Matos Sara Brandão Lopes José Eduardo Serra Eugénia Ferreira José Saraiva da Cunha Mortality predictive factors of people living with human immunodeficiency virus and bloodstream infection International Journal of Infectious Diseases Bloodstream infection Human immunodeficiency virus patients Mortality predictors |
| title | Mortality predictive factors of people living with human immunodeficiency virus and bloodstream infection |
| title_full | Mortality predictive factors of people living with human immunodeficiency virus and bloodstream infection |
| title_fullStr | Mortality predictive factors of people living with human immunodeficiency virus and bloodstream infection |
| title_full_unstemmed | Mortality predictive factors of people living with human immunodeficiency virus and bloodstream infection |
| title_short | Mortality predictive factors of people living with human immunodeficiency virus and bloodstream infection |
| title_sort | mortality predictive factors of people living with human immunodeficiency virus and bloodstream infection |
| topic | Bloodstream infection Human immunodeficiency virus patients Mortality predictors |
| url | http://www.sciencedirect.com/science/article/pii/S1201971221005221 |
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