Roberto Manfredi1, Leonardo Calza, Francesco Chiodo. 1. Department of Clinical and Experimental Medicine, Division of Infectious Diseases, University of Bologna, S. Orsola Hospital, Bologna, Italy. manfredi@med.unibo.it
Abstract
BACKGROUND: Cellulitis and soft tissue infection are underestimated complications of HIV disease. PATIENTS AND METHODS: Sixty-seven bacteriologically proven consecutive episodes were identified among 2221 HIV-infected patients hospitalized in a 10-year period, and assessed according to several epidemiological, microbiological and clinical variables. RESULTS: Staphylococcus aureus was the most frequently cultured pathogen (50% of 92 isolates), followed by Pseudomonas spp., Escherichia coli and Streptococcus pyogenes; a polymicrobial infection was present in 38.1% of episodes. Drug addiction (p < 0.003) and male gender (p < 0.04) were significantly associated with the occurrence of these complications, which were community-acquired in 83.6% of cases. While a remarkable variation in the severity of underlying immunodeficiency was shown, hematogenous dissemination occurred in 25.4% of episodes, and proved significantly related to a low CD4+ lymphocyte count, and neutropenia. A 21.7% methicillin-resistance rate was shown among S. aureus isolates. All episodes were favorably treated in 5-16 days, in over 60% of cases with associated beta-lactam-aminglycoside antibiotics; a recurrence of staphylococcal cellulitis occurred in four patients only. CONCLUSION: Skin and soft tissue infections are continuing causes of morbidity in HIV-infected patients, even in the highly active antiretroviral therapy era.
BACKGROUND:Cellulitis and soft tissue infection are underestimated complications of HIV disease. PATIENTS AND METHODS: Sixty-seven bacteriologically proven consecutive episodes were identified among 2221 HIV-infectedpatients hospitalized in a 10-year period, and assessed according to several epidemiological, microbiological and clinical variables. RESULTS:Staphylococcus aureus was the most frequently cultured pathogen (50% of 92 isolates), followed by Pseudomonas spp., Escherichia coli and Streptococcus pyogenes; a polymicrobial infection was present in 38.1% of episodes. Drug addiction (p < 0.003) and male gender (p < 0.04) were significantly associated with the occurrence of these complications, which were community-acquired in 83.6% of cases. While a remarkable variation in the severity of underlying immunodeficiency was shown, hematogenous dissemination occurred in 25.4% of episodes, and proved significantly related to a low CD4+ lymphocyte count, and neutropenia. A 21.7% methicillin-resistance rate was shown among S. aureus isolates. All episodes were favorably treated in 5-16 days, in over 60% of cases with associated beta-lactam-aminglycoside antibiotics; a recurrence of staphylococcal cellulitis occurred in four patients only. CONCLUSION: Skin and soft tissue infections are continuing causes of morbidity in HIV-infectedpatients, even in the highly active antiretroviral therapy era.
Authors: John S Cho; Eric M Pietras; Nairy C Garcia; Romela Irene Ramos; David M Farzam; Holly R Monroe; Julie E Magorien; Andrew Blauvelt; Jay K Kolls; Ambrose L Cheung; Genhong Cheng; Robert L Modlin; Lloyd S Miller Journal: J Clin Invest Date: 2010-04-01 Impact factor: 14.808
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Authors: G Peralta; E Padrón; M P Roiz; I De Benito; J C Garrido; F Talledo; M J Rodríguez-Lera; L Ansorena; M B Sánchez Journal: Eur J Clin Microbiol Infect Dis Date: 2006-10 Impact factor: 5.103