Bacteremia in hospitalized patients with human immunodeficiency virus: A prospective, cohort study

Afessa, Bekele; Morales, Ian J.; Weaver, Bethany A.

doi:10.1186/1471-2334-1-13

Cited by 27 publications

(36 citation statements)

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“…3 BSI are associated with increased mortality rate, length of hospital stay and intensive care unit (ICU) admission rate. 11 BSI are now a more frequent cause of ICU admission than Pneumocystis jiroveci pneumonia in HIV-infected patients. 12,13 Nontyphoid salmonella, Streptococcus pneumoniae, Escherichia coli and Staphylococcus aureus are the most important pathogens of BSI.…”

Section: Introductionmentioning

confidence: 99%

Bloodstream infections in HIV-infected patients

2016

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In the combined antiretroviral therapy era, HIV-infected patients remain a vulnerable population for the onset of bloodstream infections (BSI). Worldwide, nontyphoid salmonellae, Streptococcus pneumoniae, Escherichia coli, Staphylococcus aureus and coagulase negative staphylococci are the most important pathogens. Intravenous catheter associated infection, skin-soft tissue infection and endocarditis are associated with Gram-positive bacteremia. Among the Gram-negative, nontyphoidal Salmonella have been previously correlated to sepsis. Other causes of BSI in HIVinfected patients are mycobacteria and fungi. Mycobacteria constitute a major cause of BSI in limited resource countries. Fungal BSI are not frequent and among them Cryptococcus neoformans is the most common life-threatening infection. The degree of immunosuppression remains the key prognostic factor leading to the development of BSI.

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Section: Introductionmentioning

confidence: 99%

Bloodstream infections in HIV-infected patients

2016

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“…The current treatment guidelines for pneumococcal systemic disease (sepsis and meningitis) recommend penicillin, amoxicillin, or broad-spectrum cephalosporins (if risk factors are present) and vancomycin, possibly in combination with rifampin, if penicillin resistance is suspected (12,20). Even when appropriate antibiotic therapy is given, the overall case fatality rate for pneumococcal disease remains about 20%, and the mortality rate for pneumococcal bacteremia has remained unchanged since the 1950s (1,2). Following pneumococcal meningitis, the mortality rate and the frequency of long-term neurological damage in survivors are very high (6,17) and have remained unchanged for the last 40 years (50).…”

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confidence: 98%

“…Despite the availability of antimicrobial drugs, Streptococcus pneumoniae is the number one cause of bacterial pneumonia (52) and otitis media, the most frequent cause of sepsis in human immunodeficiency virus-infected patients (2), and the second most frequent cause of meningitis in all age groups (35). From the latest data, the prevalence of penicillin resistance in S. pneumoniae is 18.2% and the prevalence of macrolide resistance is 24.6% (31), yet about 3% of pneumococcal isolates in the United States may be tolerant to vancomycin and may be associated with treatment failure (51).…”

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confidence: 99%

Antibacterial Activity of a Competence-Stimulating Peptide in Experimental Sepsis Caused by Streptococcus pneumoniae

Oggioni

Iannelli

Ricci

et al. 2004

Antimicrob Agents Chemother

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Streptococcus pneumoniae, a major cause of human disease, produces a 17-mer autoinducer peptide pheromone (competence-stimulating peptide [CSP]) for the control of competence for genetic transformation. Due to previous work linking CSP to stress phenotypes, we set up an in vivo sepsis model to assay its effect on virulence. Our data demonstrate a significant increase in the rates of survival of mice, reductions of blood S. pneumoniae counts, and prolonged times to death for mice treated with CSP. In vitro the dose of CSP used in the animal model produced a transitory inhibition of growth. When a mutant with a mutation in the CSP sensor histidine kinase was assayed, no bacteriostatic phenotype was detected in vitro and no change in disease outcome was observed in vivo. The data demonstrate that CSP, which induces in vitro a temporary growth arrest through stimulation of its cognate histidine kinase receptor, is able to block systemic disease in mice. This therapeutic effect is novel, in that the drug-like effect is obtained by stimulation, rather than inhibition, of a bacterial drug target.Despite the availability of antimicrobial drugs, Streptococcus pneumoniae is the number one cause of bacterial pneumonia (52) and otitis media, the most frequent cause of sepsis in human immunodeficiency virus-infected patients (2), and the second most frequent cause of meningitis in all age groups (35). From the latest data, the prevalence of penicillin resistance in S. pneumoniae is 18.2% and the prevalence of macrolide resistance is 24.6% (31), yet about 3% of pneumococcal isolates in the United States may be tolerant to vancomycin and may be associated with treatment failure (51). The current treatment guidelines for pneumococcal systemic disease (sepsis and meningitis) recommend penicillin, amoxicillin, or broad-spectrum cephalosporins (if risk factors are present) and vancomycin, possibly in combination with rifampin, if penicillin resistance is suspected (12,20). Even when appropriate antibiotic therapy is given, the overall case fatality rate for pneumococcal disease remains about 20%, and the mortality rate for pneumococcal bacteremia has remained unchanged since the 1950s (1, 2). Following pneumococcal meningitis, the mortality rate and the frequency of long-term neurological damage in survivors are very high (6, 17) and have remained unchanged for the last 40 years (50). These facts continue to foster the search for novel drug targets and drugs in order to develop novel options for the treatment of infections caused by this pathogen (40,64,70).One of the major ways in which bacteria sense environmental signals is by using two-component and phosphorelay signal transduction systems (44, 63). Generally, two-component systems (TCSs) are composed of a sensor histidine protein kinase that is activated by a specific environmental signal and a response regulator that is a transcription factor. The sensor histidine kinases are commonly integral membrane proteins that, when stimulated by a specific signal, have an autokinase a...

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“…Descriptive analyses of the demographic and clinical characteristics of the study patients were conducted, including gender, age (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)30-39, 40-49 and 50 years), race/ethnicity (White non-Hispanic, Black nonHispanic, Hispanic, other, or missing), HIV transmission risk factor, CD4 count (o50, 51-200, 201-350, 351-500 or 4500 cells/mL), HIV-1 RNA ( 400, 401-1000, 1001-10 000, 10 001-100 000 or 4100 000 HIV-1 RNA copies/ mL), receipt of HAART and insurance. To retain patients in analyses, categories of 'missing' were included for race, risk factor, insurance, CD4 cell count and HIV-1 RNA.…”

Section: Analysesmentioning

confidence: 99%

Incidence of and risk factors for bacteraemia in HIV-infected adults in the era of highly active antiretroviral therapy

Wilson

et al. 2011

HIV Medicine

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Background HIV‐infected patients have an increased risk for bacteraemia compared with HIV‐negative patients. Few data exist on the incidence of and risk factors for bacteraemia across time in the current era of highly active antiretroviral therapy (HAART). Methods We assessed the incidence of bacteraemia among patients followed between 2000 and 2008 at 10 HIV Research Network sites. This large multisite, multistate clinical cohort study collected demographic, clinical and therapeutic data longitudinally. International Statistical Classification of Diseases and Related Health Problems (ICD)‐9 codes were examined to identify all cases of in‐patient bacteraemia. Logistic regression analysis was used to assess risk factors for bacteraemia and trends over time in the odds of bacteraemia. Results A total of 39 318 patients were followed for 146 289 person‐years (PY). During the study period, there were 2025 episodes of bacteraemia (incidence 13.8 events/1000 PY). The most common bacteraemia diagnosis was ‘bacteraemia, not otherwise specified (NOS)’ (51%) followed by Staphylococcus aureus (16%) and Streptococcus species (6.5%). In multivariate analysis, the likelihood of bacteraemia was found to have increased in 2005–2008, compared with 2000. Other factors associated with higher odds of bacteraemia included a history of injection drug use (IDU), age ≥50 years, Black race and greater immunosuppression. Conclusions The likelihood of bacteraemia has risen slightly in recent years. Patients who are Black or have a history of IDU are at higher risk. Further research is needed to identify reasons for this increase and to evaluate programmes designed to reduce the bacteraemia risk.

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Bacteremia in hospitalized patients with human immunodeficiency virus: A prospective, cohort study

Cited by 27 publications

References 28 publications

Bloodstream infections in HIV-infected patients

Bloodstream infections in HIV-infected patients

Antibacterial Activity of a Competence-Stimulating Peptide in Experimental Sepsis Caused by Streptococcus pneumoniae

Incidence of and risk factors for bacteraemia in HIV-infected adults in the era of highly active antiretroviral therapy

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