De Matos Andreia1, Brandão Lopes Sara2, Serra José Eduardo3, Ferreira Eugénia4, Saraiva da Cunha José5. 1. Internal Medicine department, Coimbra Hospital and University Center, Coimbra, Portugal; Faculty of Medicine, University of Coimbra. Electronic address: a.margarida_matos@hotmail.com. 2. Infectious disease department, Coimbra Hospital and University Center, Coimbra, Portugal. Electronic address: sarabrandaolopes@gmail.com. 3. Infectious disease department, Coimbra Hospital and University Center, Coimbra, Portugal. Electronic address: jeduardoserra@yahoo.com. 4. Infectious disease department, Coimbra Hospital and University Center, Coimbra, Portugal. 5. Internal Medicine department, Coimbra Hospital and University Center, Coimbra, Portugal; Faculty of Medicine, University of Coimbra. Electronic address: saraiva@chuc.min-saude.pt.
Abstract
INTRODUCTION: Portugal had one of the highest people living with human-immunodeficiency-virus (PLWHIV) mortality rates in Europe, although it is declined after antiretroviral therapy introduction such as bloodstream infections (BSI) mortality in these patients. However BSI mortality is still high and with few European data. So, characterizing BSI and defining prognostic factors may improve our approach. METHODOLOGY: Ten-year retrospective study of 30-day and 3-year mortality predictive factors in PLWHIV and BSI from a tertiary infectious diseases ward. RESULTS: Of 2134 admissions, 145 (6.8%) had BSI, mostly respiratory and catheter-related bacteremia and globally community-acquired. Nosocomial infectious occurred in 42 (36%), mostly by Enterococcus sp, S. aureus and Candida sp. PLWHIV and BSI had higher 30-day mortality (27%) comparing to without BSI (14%). APACHE-II, corticotherapy and current intravenous drug use (IDU) had prognostic impact in 30-day mortality. Three-year survival was 54% in PLWHIV and BSI with CD4-cell count fewer than 200, vascular or chronic pulmonary disease and lymphoma as prognostic factors. CONCLUSION: Patients with BSI were more likely to present advanced HIV disease, more comorbidities, longer length of stay and higher 30-day mortality. IDU and severity of infection determined short-term prognosis. Three-year mortality was primarily influenced by lower CD4-cell counts, hematologic tumor and cardiopulmonary comorbidities. The influence of systemic corticotherapy in nosocomial BSI and short-term prognosis was suggested.
INTRODUCTION: Portugal had one of the highest people living with human-immunodeficiency-virus (PLWHIV) mortality rates in Europe, although it is declined after antiretroviral therapy introduction such as bloodstream infections (BSI) mortality in these patients. However BSI mortality is still high and with few European data. So, characterizing BSI and defining prognostic factors may improve our approach. METHODOLOGY: Ten-year retrospective study of 30-day and 3-year mortality predictive factors in PLWHIV and BSI from a tertiary infectious diseases ward. RESULTS: Of 2134 admissions, 145 (6.8%) had BSI, mostly respiratory and catheter-related bacteremia and globally community-acquired. Nosocomial infectious occurred in 42 (36%), mostly by Enterococcus sp, S. aureus and Candida sp. PLWHIV and BSI had higher 30-day mortality (27%) comparing to without BSI (14%). APACHE-II, corticotherapy and current intravenous drug use (IDU) had prognostic impact in 30-day mortality. Three-year survival was 54% in PLWHIV and BSI with CD4-cell count fewer than 200, vascular or chronic pulmonary disease and lymphoma as prognostic factors. CONCLUSION:Patients with BSI were more likely to present advanced HIV disease, more comorbidities, longer length of stay and higher 30-day mortality. IDU and severity of infection determined short-term prognosis. Three-year mortality was primarily influenced by lower CD4-cell counts, hematologic tumor and cardiopulmonary comorbidities. The influence of systemic corticotherapy in nosocomial BSI and short-term prognosis was suggested.