HAEMOPHILUS SPECIES BACTEREMIA IN ADULTS - THE IMPORTANCE OF THE HUMAN-IMMUNODEFICIENCY-VIRUS EPIDEMIC

Background: Until the late 1970s, invasive infections caused by Haemop hilus species were thought to occur mainly in children and only infreq uently in adults. Objective: To report the largest series to date of H aemophilus species bacteremia (HE) from a single center. Design: Retro spective. Setting: large, tertiary care, general teaching hospital. Me thods: We reviewed the charts of adult patients with HE detected from January 1, 1986, to December 31, 1994. Haemophilus strains were seroty ped, and the antimicrobial resistance pattern was analyzed. Results: O ne hundred sixteen patients had HE (0.26 cases per 1000 admissions). T hirty-eight children and 16 adults were excluded. Human immunodeficien cy virus (HIV) infection was the most common underlying condition (n=1 8 [29%]), followed by malignant neoplasms (n=12 [19%]) and chronic obs tructive pulmonary disease (n=12 [19%]). Prevalence in HIV-positive pa tients was 5 cases per 1000 admissions vs 0.2 cases per 1000 admission s in HIV-negative patients. Infection was nosocomial in 16 patients (2 6%). Focal diseases were pneumonia in 41 patients (66%), cholangitis i n 5 patients (8%), endocarditis in 3 patients (5%), meningitis and sep tic arthritis each in 1 patient (2%), and primary bacteremia in 9 pati ents (14%). The HIV-positive patients were significantly younger and p resented more frequently with pneumonia (P<.05). Overall, 14 patients died (22%). Bacteremia was polymicrobial in 11 patients (18%). Haemoph ilus influenzae was isolated in 53 patients (85%). Rates of antimicrob ial resistance were 11% to chloramphenicol sodium succinate, 48% to am picillin sodium, 78% to erythromycin stearate, 76% to combined sulfame thoxazole and trimethoprim, 15% to rifampin, and 57% to clarithromycin . Conclusions: Infection with HIV has become the most common underlyin g disease in adults with HE in our hospital. Therapeutic approaches mu st take into account the high rate of antimicrobial resistance.