Bacterial pneumonia in HIV‐infected patients: use of the pneumonia severity index and impact of current management on incidence, aetiology and outcome

Abstract

ObjectivesDespite a recent decrease, bacterial pneumonia (BP) is still the most common admission diagnosis in HIV patients. We analyse BP incidence, characteristics and prevention measures. MethodsObservational study of all patients hospitalized for BP in a tertiary hospital in Barcelona, Spain, from January 2000 to December 2005. Demographic and HIV-related data, BP risk factors, characteristics of BP and outcomes are analysed. ResultsOne hundred and eighty-six BP episodes in 161 patients were included; patients were mainly male (73.7%) and intravenous drug users (73.7%). A decrease in BP incidence was seen during the study period, especially in vaccinated patients. The most commonly isolated microorganism was Streptococcus pneumoniae (31.7%), followed by Legionella pneumophila (5.9%). Legionella pneumophila was more likely in patients with undetectable viral load, higher CD4 cell counts or prior vaccination. Highly active antiretroviral therapy, cotrimoxazole prophylaxis and pneumococcal vaccination did not have a significant influence on bacteraemia rate, in-hospital complications or BP mortality. High Pneumonia Severity Index (PSI) predicted mortality accurately [relative risk 15.2, 95% confidence interval 3.2-71.7; P 5 0.001]. Mortality was 9.1%, but was significantly higher in patients with CD4 counts under 200 cells/mL (P 5 0.022). ConclusionsA decline in BP incidence was seen during the study period. Combining CD4 cell count and PSI score could become a good strategy in deciding which patients have to be hospitalized.

Trends in mortality and antibiotic resistance among HIV‐infected patients with invasive pneumococcal disease

“…It is well known that HIV-infected persons are at higher risk for IPD than the general population [4][5][6]8]. Our previous report [10] and others [4,5] have shown that rates of IPD decreased among HIV-infected patients in the early HAART era but remained higher than in the non-HIV-infected population.…”

“…Our previous report [10] and others [4,5] have shown that rates of IPD decreased among HIV-infected patients in the early HAART era but remained higher than in the non-HIV-infected population. In the present study, we found that in the late HAART era the rates of IPD did not significantly decrease with respect to the early HAART era; this may be a result, at least in part, of the increased prevalence of HIV-infected patients with associated comorbidities, which are well known risk factors for IPD.…”

“…Several studies have demonstrated a decrease in the incidence of bacterial pneumonia and invasive pneumococcal disease (IPD) in HIV-infected patients that was mainly associated with the introduction of HAART [2][3][4][5] and 7-valent pneumococcal conjugate vaccine (PCV7) for children [6]. However, the incidence rates of IPD in HIVinfected patients remain high [7,8] and a recent population-based study from Denmark showed that the incidence of overall pneumonia in HIV-infected patients remains higher than in the general population [9].…”

Impact of macrolide therapy on mortality of HIV-infected patients with community-acquired pneumonia in a tertiary teaching hospital

“…Therefore, patients with CD4 < 200 cells/µL or high severity scores would be considered severe cases. 2,10 Patient severity assessment is important for decision-making regarding the type of treatment and where the latter must be carried out. In fact, choosing the empiric treatment for bacterial pneumonia in HIV-infected patients is a great challenge, as most studies and consensus are directed at immunocompetent patients.…”

“…2 The Pneumonia Severity Index (PSI) consists of interesting rules that can predict mortality in HIV-infected patients. 10 Another interting severity score is the CURB-65, adopted by the Brazilian Consensus of CAP due to its simplicity 11 (patients are considered severe when they have a score of IV or V at PSI or a score ≥ 3 at CURB-65).…”