Predicting bacteremic pneumonia in HIV-1–infected patients consulting the ED

Perelló, Rafael; Miró, Òscar; Marcos, María Angeles; Almela, Manel; Bragulat, Ernest; Sánchez, Miquel; Agustí, Carlos; Miro, José M.; Moreno, Asunción

doi:10.1016/j.ajem.2009.01.024

« Previous Next »American Journal of Emergency Medicine
Volume 28, Issue 4 , Pages 454-459, May 2010

Predicting bacteremic pneumonia in HIV-1–infected patients consulting the ED

Rafael Perelló, MD
- Emergency Department, Hospital Clínic, Barcelona, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), University of Barcelona 08036, Spain
- Corresponding author. Emergency Department, Hospital Clínic of Barcelona, 08036 Barcelona, Catalonia, Spain. Tel.: +34 93 227 98 33; fax: +34 93 227 56 93.
Òscar Miró, MD, PhD
- Emergency Department, Hospital Clínic, Barcelona, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), University of Barcelona 08036, Spain
María Angeles Marcos, MD, PhD
- Microbiological Department, Hospital Clínic, Barcelona, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), University of Barcelona 08036, Spain
Manel Almela, MD, PhD
- Microbiological Department, Hospital Clínic, Barcelona, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), University of Barcelona 08036, Spain
Ernest Bragulat, MD, PhD
- Emergency Department, Hospital Clínic, Barcelona, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), University of Barcelona 08036, Spain
Miquel Sánchez, MD, PhD
- Emergency Department, Hospital Clínic, Barcelona, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), University of Barcelona 08036, Spain
Carlos Agustí, MD
- Pneumology Department, Hospital Clínic, Barcelona, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), University of Barcelona 08036, Spain
José M. Miro, MD, PhD
- Infectious Department, Hospital Clínic, Barcelona, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), University of Barcelona 08036, Spain
Asunción Moreno, MD, PhD
- Infectious Department, Hospital Clínic, Barcelona, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), University of Barcelona 08036, Spain

Received 4 July 2008; received in revised form 26 November 2008; accepted 16 January 2009. published online 26 March 2010.

Abstract

Introduction

HIV-1–infected patients have higher incidence of community-acquired pneumonia (CAP) and risk of complications. Bacteremia has been associated with a higher risk of complications in such patients. We investigated factors associated with bacteremia in HIV-1–infected patients with CAP presenting at the emergency department.

Methods

We included HIV-1–infected patients with CAP for 3 years (March 2005-February 2008). Only patients in whom blood cultures were performed were finally included. Clinical data (age; sex; CD4⁺ count; serum HIV viral load; previous or current intravenous drug use and antiretroviral treatment; systolic blood pressure; and cardiac and respiratory rates), analytical data (leukocyte count, arterial oxygen content, C-reactive protein value, and urgent Streptococcus pneumoniae and Legionella spp antigen urine detection), and APACHE-II (Acute Physiology and Chronic Health Evaluation) score were compiled. The need for intensive care unit admission, mechanical ventilation, mortality, and for patients finally discharged, duration of admission were retrospectively obtained from the clinical history. A multivariate analysis using logistic regression was performed to find independent predictors of bacteremia.

Results

We diagnosed 129 HIV-1–infected patients with CAP. Blood cultures were performed in 118 cases (91%). Bacteremia was present in 28 (24%). Independent predictors of bacteremia were the detection of S pneumoniae antigen in urine (odds ratio, 9.0; 95% confidence interval, 1.9-42.0) and the absence of current antiretroviral treatment (odds ratio, 7.1; 95% confidence interval, 1.4-33.3). In-hospital mortality was higher in patients with bacteremia (15% vs 0%).

Conclusion

HIV-1–infected patients with CAP who are not on current antiretroviral therapy and have positive S pneumoniae antigenuria are at increased risk of having bacteremia. Bacteremic patients have a poor outcome.