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Pneumococcal Bacteremic Pneumonia in Patients with Human Immunodeficiency Virus (HIV)
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A5538 - Pneumococcal Bacteremic Pneumonia in Patients with Human Immunodeficiency Virus (HIV)
Author Block: M. Fielli1, C. D. Guzman1, P. Idoyaga1, J. Burgos Gomez1, G. Yusti2, A. Fernandez3, A. Gonzalez1; 1Pneumonology, Hospital Nacional A Posadas, El Palomar, Argentina, 2Pneumonology, Hospital Posadas, El Palomar, Argentina, 3Microbiology, Hospital Nacional A Posadas, El Palomar, Argentina.
INTRODUCTION: Pulmonary infections in patients with human immunodeficiency virus (HIV)are a major cause of morbidity and mortality.The introduction of highly active antiretroviral therapy (HAART) has led to a decline in the occurrence of opportunistic infections. However,bacterial community-acquired pneumonia (CAP)remains prevalent. There are controversies regarding the course and outcomeofHIV-positive patients with pneumococcal bacteremic pneumonia. OBJECTIVE: To compare the clinical findings, radiological features, laboratory tests and courseof pneumococcal bacteremic pneumonia in HIV patientsversus non-HIV patients. MATERIALS AND METHODS: A retrospective study of a cohort of patients withCAP and Streptococcus Pneumoniae isolated from at least one blood culture, between January 2012 and May 2017. The following variables were analyzed: age, gender, comorbidities, clinical findings, radiological features, laboratory tests and mortality. RESULTS: We included 117 patients, 90 non-HIV and 27 HIV. The average age was higher in the non-HIV group (57.6 ± 16.8 vs 41.6 ± 12.4, p = 0.001), as well as the hospital length of stay (days: 15.4 ± 23.4 vs 8.81 ± 6.1, p = 0.04), the hematocrit (36.3% ± 6.6 vs 32.5% ±5.2, p = 0.004) and the white blood cell count (21900/mm3 ± 12725 vs 12619/mm3 ± 9700, p = 0.026). The presence of comorbidities was also statistically different (72.22% in the non-HIV vs 44.44% in the HIV, p = 0.008).The median of the CD4 value was 124/mm3 (± 307).There were 30 patients who had a CURB-65 score of 2 or more in the non-HIV group and 1 inthe HIV group (p = 0.004). No statistically significant difference was found in the following variables:ICU admission, need for mechanical ventilation or use of vasopressors agents, confusion at admission, radiological features and mortality (34.44% in the non-HIV vs 33.33% in the HIV, p = 0.915). In the laboratory tests, there were no differences in the levels of urea, creatinine or PaO2/FIO2. CONCLUSION: HIV patients from our series were younger, classified as having anon-severe CAP by CURB-65 andhadless length of hospital stay. Mortality was the same inboth groups.
Author Block: M. Fielli1, C. D. Guzman1, P. Idoyaga1, J. Burgos Gomez1, G. Yusti2, A. Fernandez3, A. Gonzalez1; 1Pneumonology, Hospital Nacional A Posadas, El Palomar, Argentina, 2Pneumonology, Hospital Posadas, El Palomar, Argentina, 3Microbiology, Hospital Nacional A Posadas, El Palomar, Argentina.
INTRODUCTION: Pulmonary infections in patients with human immunodeficiency virus (HIV)are a major cause of morbidity and mortality.The introduction of highly active antiretroviral therapy (HAART) has led to a decline in the occurrence of opportunistic infections. However,bacterial community-acquired pneumonia (CAP)remains prevalent. There are controversies regarding the course and outcomeofHIV-positive patients with pneumococcal bacteremic pneumonia. OBJECTIVE: To compare the clinical findings, radiological features, laboratory tests and courseof pneumococcal bacteremic pneumonia in HIV patientsversus non-HIV patients. MATERIALS AND METHODS: A retrospective study of a cohort of patients withCAP and Streptococcus Pneumoniae isolated from at least one blood culture, between January 2012 and May 2017. The following variables were analyzed: age, gender, comorbidities, clinical findings, radiological features, laboratory tests and mortality. RESULTS: We included 117 patients, 90 non-HIV and 27 HIV. The average age was higher in the non-HIV group (57.6 ± 16.8 vs 41.6 ± 12.4, p = 0.001), as well as the hospital length of stay (days: 15.4 ± 23.4 vs 8.81 ± 6.1, p = 0.04), the hematocrit (36.3% ± 6.6 vs 32.5% ±5.2, p = 0.004) and the white blood cell count (21900/mm3 ± 12725 vs 12619/mm3 ± 9700, p = 0.026). The presence of comorbidities was also statistically different (72.22% in the non-HIV vs 44.44% in the HIV, p = 0.008).The median of the CD4 value was 124/mm3 (± 307).There were 30 patients who had a CURB-65 score of 2 or more in the non-HIV group and 1 inthe HIV group (p = 0.004). No statistically significant difference was found in the following variables:ICU admission, need for mechanical ventilation or use of vasopressors agents, confusion at admission, radiological features and mortality (34.44% in the non-HIV vs 33.33% in the HIV, p = 0.915). In the laboratory tests, there were no differences in the levels of urea, creatinine or PaO2/FIO2. CONCLUSION: HIV patients from our series were younger, classified as having anon-severe CAP by CURB-65 andhadless length of hospital stay. Mortality was the same inboth groups.
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