The importance of bacterial sepsis in intensive care unit patients with acquired immunodeficiency syndrome: Implications for future care in the age of increasing antiretroviral resistance

Objective: To describe the clinical characteristics and outcomes of patient s with acquired immunodeficiency syndrome (AIDS) admitted to the intensive care unit (ICU). Design: An observational cohort study with retrospective chart review. Setting: ICU of an urban university medical center. Patients: consecutive ICU admissions of patients with AIDS at an urban univ ersity medical center between December 1993 and June 1996. Interventions: None. Measurements and Main Results: For each patient, we recorded ICU admission diagnosis, clinical characteristics, and outcome. Among 129 ICU admissions of patients with AIDS, 102 (79%) were admitted for infections, of which (45 %) had infections caused by bacteria. Pseudomonas aeruginosa, Staphylococcu s aureus, and other enteric pathogens were the most frequent isolates. Pneu monia accounted for 65% of 102 admissions for infections. Overall hospital mortality was 54%, but mortality was higher (68%) for patients with bacteri al sepsis. Neutropenia was associated with differences in unadjusted surviv al rates, whereas CD4 counts were not. Independent predictors of hospital m ortality included increasing acute physiology scores and severity of sepsis . Conclusions: In our IOU, among patients with AIDS, sepsis resulting from ba cterial infection is now a more frequent cause of admission than Pneumocyst is carinii pneumonia. Severity of illness and the presence of severe sepsis were the clinical predictors most associated with increased mortality. Pat ients who are not receiving or responding to highly active antiretroviral t herapy may become as likely to be admitted to an ICU with a treatable bacte rial infection as with classic opportunistic infections. Therefore, broad-s pectrum empirical antibacterial therapy is particularly important when the etiology of infection is uncertain.