BACTERIAL-INFECTIONS IN HIV-INFECTED PATIENTS

The incidence of bacterial nosocomial infection in HIV-infected patien ts is close to 10 %. Nevertheless, the development of new therapies an d invasive procedures may have increased the risk for nosocomial infec tion in these patients, who are more frequently treated outside of hos pital, at home in long-term facilities. To better understand how these bacterial infections are acquired by HIV-infected patients: and to de termine whether these infections are community-acquired or nosocomial, a longitudinal study was carried out over a 6-month period in the inf ectious diseases ward, at the Paris Pitie- Salpetriere Hospital. All H IV-infected patients hospitalized in the service were included. The ma in evaluations concerned the incidence of community-acquired, nosocomi al, and home-care acquired infections, infection sites, and microorgan isms. Among the 406 patients included, 68 patients presented at least 1 bacterial infection [incidence rate 16.7 %; 95 % Confidence Interval (CI): 13.1 % - 20.4 %]. accounting for 77 infections [incidence rate 18.9 %; 95 % CI: 10.2 % - 27.6 %]. The main infection sites were centr al venous catheter (20), pneumonia (16), bloodstream infections (10), and urinary tract infections (10). 10 infections were nosocomial, acco rding to standard definitions [incidence rate: 13.0 %; 95 % CI: 5.5 % - 20.5 %]. The other 67 infections were community-acquired, 22 were ho me-care acquired, including 18 directly related to medical devices. Co nsidering these 18 additional infections? the number of nosocomial inf ections reached at least 28 [incidence rate: 36.4 %, 95 % CI: 25,6 % - 47,1 %]. Bacterial infections are frequent in HIV-infected patients, either during hospitalization or in extra-hospital settings, such as h ome-care. Efforts to reduce nosocomial infections should be made by mo re careful compliance to indications and utilization of medical device s, such as central venous catheters.