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. 2019 Jun;98(23):e15801.
doi: 10.1097/MD.0000000000015801.

Impact of human immunodeficiency virus infection on mortality of patients who acquired healthcare associated-infection in critical care unit

Victor Augusto Camarinha de Castro-Lima  1 , Igor C Borges, Daniel Joelsons, Vivian V T Sales, Thais Guimaraes, Yeh Li Ho, Silvia F Costa, Maria Luisa N Moura
Affiliations

Impact of human immunodeficiency virus infection on mortality of patients who acquired healthcare associated-infection in critical care unit

Victor Augusto Camarinha de Castro-Lima et al. Medicine (Baltimore). 2019 Jun.

Abstract

To evaluate 30-day mortality in human immunodeficiency virus (HIV) and non-HIV patients who acquired a healthcare-associated infection (HAI) while in an intensive care unit (ICU), and to describe the epidemiological and microbiological features of HAI in a population with HIV.This was a retrospective cohort study that evaluated patients who acquired HAI during their stay in an Infectious Diseases ICU from July 2013 to December 2017 at a teaching hospital in Brazil.Data were obtained from hospital infection control committee reports and medical records. Statistical analysis was performed using SPSS and a multivariate model was used to evaluate risk factors associated with 30-day mortality. Epidemiological, clinical, and microbiological characteristics of HAI in HIV and non-HIV patients and 30-day mortality were also evaluated.Among 1045 patients, 77 (25 HIV, 52 non-HIV) patients acquired 106 HAI (31 HIV, 75 non-HIV patients). HIV patients were younger (45 vs 58 years, P = .002) and had more respiratory distress than non-HIV patients (60.0% vs 34.6%, P = .035). A high 30-day mortality was observed and there was no difference between groups (HIV, 52.0% vs non-HIV, 54.9%; P = .812). Ventilator-associated pneumonia (VAP) was more frequent in the HIV group compared with the non-HIV group (45.2% vs 26.7%, P = .063), with a predominance of Gram-negative organisms. Gram-positive agents were the most frequent cause of catheter associated-bloodstream infections in HIV patients. Although there was a high frequency of HAI caused by multidrug-resistant organisms (MDRO), no difference was observed between the groups (HIV, 77.8% vs non-HIV, 64.3%; P = .214). Age was the only independent factor associated with 30-day mortality (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.01-1.1, P = .017), while diabetes mellitus (OR: 3.64, 95% CI: 0.84-15.8, P = .085) and the Sequential Organ-Failure Assessment (SOFA) score (OR: 1.16, 95% CI: 0.99-1.37, P = .071) had a tendency to be associated with death.HIV infection was not associated with a higher 30-day mortality in critical care patients with a HAI. Age was the only independent risk factor associated with death. VAP was more frequent in HIV patients, probably because of the higher frequency of respiratory conditions at admission, with a predominance of Gram-negative organisms.

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Conflict of interest statement

No authors have conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of patients.
Figure 2
Figure 2
Number of ICU admissions, HIV patient admissions, and HAIs per month during the study period. HAI = healthcare associated-infection, HIV = human immunodeficiency virus, ICU = intensive care unit.
Figure 3
Figure 3
Leukocyte count 48 hours before, 48 hours after, and on day 1 of HAI. HAI = healthcare associated-infection, HIV = human immunodeficiency virus.
Figure 4
Figure 4
C-reactive protein 48 hours before, 48 hours after, and on day 1 of HAI. HAI = healthcare associated-infection, HIV = human immunodeficiency virus.
See this image and copyright information in PMC

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