Nosocomial bloodstream infections in HIV-infected patients: Attributable mortality and extension of hospital stay

A 3-year prospective matched case-control study was performed to investigat e the potential risk factors, prognostic indicators, extension of hospital stay, and attributable mortality of nosocomial bloodstream infections in HI V-infected patients. Matching variables were: age, gender, number of circul ating CD4(+) T lymphocytes, cause of hospital admission, hospitalization in the same ward within the 6 weeks of diagnosis of the case, and length of s tay before the day of infection in the case. Eighty-four cases and 168 matc hed controls were studied. Nosocomial bloodstream infections complicated ab out 3 of 1000 hospital days per patient in the study period. With step-wise logistic regression analysis, the most important predictors for developing nosocomial bloodstream infections were: increasing value of Acute Physiolo gy and Chronic Health Evaluation (APACHE II) score (p =.001) and use of cen tral venous catheter (CVC) (p =.002). The excess of hospital slay attributa ble to nosocomial bloodstream infections was 17 days. The crude mortality r ate was 43%. The attributable mortality rate was estimated to be 27% (95% c onfidence interval [CI] = 13%-48%). The estimated risk ratio for death was 3.91 (95% CI = 2.06-7.44). Multivariate analysis identified two prognostic indicators that were significantly associated with unfavorable outcome of b loodstream infections: number of circulating CD4(+) T cells <100/mm(3) (p = .002) and APACHE II score >15 (p =.01). Nosocomial bloodstream infections a re more common in patients with advanced HIV disease. Important cofactors a re high APACHE II score and use of CVC. These infections can cause an exces s mortality and significantly prolong the hospital stay of HIV-infected pat ients.