Incidence and determinants of Pseudomonas aeruginosa infection among persons with HIV: Association with hospital exposure

• Published in: American journal of infection control Vol. 29; no. 2; pp. 79 - 84
• Main Authors: Sorvillo, Frank, Beall, Gildon, Turner, Paul A., Beer, Victor L., Kovacs, Andrea A., Kerndt, Peter R.
• Format: Journal Article
• Language: English
• Published: St. Louis, MO Mosby, Inc 01.04.2001; Mosby
• Subjects: Adolescent; Adult; AIDS-Related Opportunistic Infections - epidemiology; AIDS-Related Opportunistic Infections - etiology; AIDS-Related Opportunistic Infections - prevention & control; AIDS-Related Opportunistic Infections - transmission; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Azithromycin - therapeutic use; Biological and medical sciences; CD4 Lymphocyte Count; Cohort Studies; Cross Infection - epidemiology; Cross Infection - etiology; Cross Infection - prevention & control; Cross Infection - transmission; Dapsone - adverse effects; Female; Health Behavior; Hospitalization - statistics & numerical data; Human viral diseases; Humans; Incidence; Infection Control; Infectious diseases; Length of Stay - statistics & numerical data; Los Angeles - epidemiology; Male; Medical sciences; Middle Aged; Multivariate Analysis; Pseudomonas aeruginosa; Pseudomonas Infections - epidemiology; Pseudomonas Infections - etiology; Pseudomonas Infections - prevention & control; Pseudomonas Infections - transmission; Risk Factors; Risk-Taking; Trimethoprim, Sulfamethoxazole Drug Combination - adverse effects; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; California; United States; North America; America; Los Angeles; Pseudomonadales; Human; Immunopathology; Nosocomial infection; AIDS; Epidemiology; Immune deficiency; Incidence; Infection; Community acquired infection; Viral disease; Risk factor; Bacteriosis; Bacteria; Pseudomonadaceae; Complication; Pseudomonas aeruginosa
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1067/mic.2001.110367

Background: Little information exists on risk factors for Pseudomonas aeruginosa infection in persons with HIV. We assessed the incidence and factors associated with P aeruginosa among persons with HIV enrolled in a large observational cohort study in Los Angeles. Methods: Data were analyzed from 4825 persons aged ≥13 years with HIV infection enrolled from 4 outpatient facilities from 1990 to 1998. The association between P aeruginosa infection and demographic, risk behavior, and clinical factors was assessed. Results:P aeruginosa was diagnosed in 72 (1.5%) patients representing a crude incidence rate of 0.74 per 100 person-years. The most frequent site of infection was pulmonary (47%). In multivariate analysis, prior hospitalization (adjusted rate ratio = 7.9, 95% CI, 3.8-16.2), and both dapsone (adjusted rate ratio = 4.0, 95% CI, 2.2-7.4) and trimethoprim-sulfamethoxazole (adjusted rate ratio = 2.5, 95% CI, 1.2-5.3) use were independently associated with higher rates of infection. Increasing days of inpatient stay (P <.01) and decreasing CD4+ counts (P <.01) were strongly associated with P aeruginosa. Azithromycin use decreased the risk of infection by nearly 70%. Conclusion: Although the overall observed incidence of P aeruginosa was low, hospital exposure, declining CD4+ levels, and the use of dapsone or trimethoprim-sulfamethoxazole increased the risk of P aeruginosa disease, and azithromycin use was protective in this population. These findings may assist in the early recognition and diagnosis of persons likely to be at increased risk of P aeruginosa infection. (AJIC Am J Infect Control 2001;29:79-84)