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

Abstract

ObjectivesIndividuals infected with HIV-1 are at an increased risk of Staphylococcus aureus bacteraemia (SAB). The aim of this study was to investigate mortality rate and risk of reinfection associated with SAB in HIV-1-infected individuals compared to individuals without HIV-1 infection.SettingUniversity hospital treating a third of the estimated 5000 individuals with HIV infection in Denmark.ParticipantsHIV-1-infected (n=82) and sex-matched and age-matched uninfected (n=163) individuals with SAB in the time period 1 January 1995 to 31 December 2010.Primary outcome measures30-day and 365-day mortality rate ratio and relative risk of reinfection.ResultsIndividuals with HIV had an increased risk of death at day 30 (OR 11.90 (95% CI 2.15 to 65.85)) compared to individuals without HIV. Other factors associated with mortality were age, a foreign device and Pitt score. HIV-related factors did not associate to mortality. During follow-up, there were 43 episodes of reinfection; in individuals with HIV infection at an incidence rate of 7.8 (95% CI 4.7 to 10.9)/100 person-years compared with 2.2 (95% CI 1.2 to 3.2)/100 person-years for individuals without HIV. In multivariate analysis, HIV status (OR 2.91 (95% CI 1.29 to 6.58) and injection drug use (OR 3.51 (95% CI 1.06 to 11.63) were independently associated with an increased risk of reinfection.ConclusionsHIV-1 infection is associated with an increased risk of 30-day mortality after SAB and a very high rate of reinfection. Age, a foreign device and Pitt score predicted outcome. For patients infected with HIV, neither CD4 T-lymphocyte counts nor plasma HIV RNA levels were associated with 30-day outcome.Trial registration numberThe study was approved by the Danish Data Protection Agency (record no. 2007-41-1196).

The management and outcomes of Staphylococcus aureus bacteraemia at a South African referral hospital: A prospective observational study

“…Although the short-term outcomes of medical patients at Groote Schuur Hospital are generally poor, with only 65% surviving to 12 months post-discharge (Stuart-Clark et al, 2012), this does not fully explain the poor early outcomes observed in this study, where the majority of deaths were possibly SAB-related. Over a fifth of the patients had an HIV co-infection, but this was not associated with mortality or complicated infection, in contrast to other reports (Jaliff et al, 2014). This suggests that specific host-or pathogen-related factors may account for the worse outcomes observed compared to other settings.…”

Efficacy of seven and fourteen days of antibiotic treatment in uncomplicated Staphylococcus aureus bacteremia (SAB7): study protocol for a randomized controlled trial

“…Based on local and national databases, we expect a failure to treat and relapse rate of < 5% for patients with uncomplicated SAB alive at day 7 and a 90-day all-cause mortality rate of approximately 7%, corresponding to a recovery rate of 88% [20]. However, available data on recurrence and death in this select group of patients is sparse.…”

Epidemiology and management of healthcare-associated bloodstream infections in non-neutropenic immunosuppressed patients: a review of the literature

“…40–42 Injection drug users are at very high risk of repeated BSIs due to S. aureus including methicillin-resistant strains. 43–45 Recently, countries with high IDU reported increases in BSI rates. 29,31 HIV patients represent a particularly high risk group for invasive disease with S. pneumoniae , both in developing and developed countries except for Southeast Asia where 47% BSIs are caused by NTS.…”

“…45 Recent evidence suggests that MRSA and CA-MRSA are becoming an emerging epidemic among HIV patients in some developed countries. 43,45 Therefore, depending on the local epidemiology, empirical use of glycopeptides or daptomycin can be considered in those settings. 49 In Africa and Southeast Asia, NTS show high prevalence of multidrug resistance, particularly to antibiotics regarded as first line in low resource settings, that is, ampicillin, chloramphenicol, and co-trimoxazole.…”