Pseudomonas aeruginosa bacteremia in patients infected with human immunodeficiency virus type 1

A prospective analysis of 43 episodes of Pseudomonas aeruginosa bacteremia in HIV-l-infected subjects was performed and the results compared with the incidence and outcome of Pseudomonas aeruginosa bacteremia in other high-ri sk patients, such as transplant recipients, leukemia patients, or patients hospitalized in the intensive care unit. The incidence of bacteremia/fungem ia as a whole and of gram-negative and Pseudomonas aeruginosa bacteremia in particular was greater in HIV-l-infected subjects than in the unselected g eneral population admitted. In contrast, the incidence of Pseudomonas aerug inosa bacteremia in HIV-l-infected patients did not differ from that in pat ients with other high-risk conditions. In patients with HIV-1 infection, in dependent risk factors for presenting Pseudomonas aeruginosa bacteremia wer e nosocomial origin (OR, 2.7; 95% CI, 1.3-5.7), neutropenia (OR, 2.7; 95% C I, 1.07-6.8), previous treatment with cephalosporins (OR, 3.6; 95% CI, 1.1- 11.6), and a CD4+ cell count lower than 50 cells/mm(3) (OR, 3.1; 95% CI, 1. 7-8.6). Primary bacteremia and pneumonia were the most common forms of pres entation. Fourteen (33%) patients died as a consequence of the bacteremia. The presence of severe sepsis (OR, 17.5; 95% CI, 3.2-68) and the institutio n of inappropriate definitive antibiotic therapy (OR, 2.7; 95% CI, 1.1-13) were independently associated with a poor outcome. One year after the devel opment of bacteremia, only eight (19%) patients remained alive.