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

Abstract

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.

Outcome and reinfection afterStaphylococcus aureusbacteraemia in individuals with and without HIV-1 infection: a case–control study

“…For this reason, we adjusted for age in all analysis. Individuals with HIV infection acquire SAB at a younger age6 and the age of the patients included in this study is similar to that of patients in other studies examining HIV-associated SAB4 25 indicating that the results are applicable to the general HIV population.…”

Systemic Staphylococcus aureus infection mediated by Candida albicans hyphal invasion of mucosal tissue

“…Immunocompromised hosts represent a significant and appropriate patient population to model, as these patients frequently suffer from infections and diseases of the oral mucosa and bloodstream that involve C. albicans and S. aureus (Bassetti et al, 2012;Delorenze et al, 2013;Dongari-Bagtzoglou et al, 2009;Marukutira et al, 2014;Olczak-Kowalczyk et al, 2012;Stammler Jaliff et al, 2014;Yehia et al, 2011). Additionally, a recent pair of studies found that among HIV positive individuals, S. aureus could be isolated from the oral cavity of 92 % of individuals while C. albicans was isolated from 73 % of the study subjects (Back-Brito et al, 2009, 2011, suggesting our model is highly relevant clinically.…”

Nasal colonization with Staphylococcus aureus in individuals with HIV/ AIDS attended in a Brazilian Teaching Hospital

“…The use of antimicrobials has also been documented as a risk factor for colonization with Staphylococcus aureus in individuals with HIV (10) .…”