Study objectives: To describe the causative organisms
and factors associated with bacterial pneumonia and to assess its
impact on the outcome of hospitalized patients with HIV.
Design: Prospective, observational.
Setting: A university-affiliated medical center.
Methods: We included 1,225 consecutive hospital admissions,
from April 1995 through March 1998, of 599 adults with HIV. We
collected data on APACHE II (acute physiology and chronic health
evaluation II) score, leukocyte and CD4+ lymphocyte counts, length of
hospital stay, ICU admission rate, and case-fatality rate. Chest
radiographs and laboratory results were reviewed. The presence of
bacterial pneumonia was noted.
pneumonia was diagnosed in 111 hospitalizations (9%): 80 (72%) were
community-acquired infections. The CD4+ lymphocyte count was lower
(median, 38 vs 66/μL, p = 0.0027), APACHE II score higher (17 vs
13, p < 0.0001), length of hospital stay longer (median, 6 vs 4),
and ICU admission (28% vs 9%) and case-fatality rates (21% vs 4%)
higher in patients with bacterial pneumonia compared with those without
bacterial pneumonia. The most common pathogen was Pseudomonas
aeruginosa (32 admissions), followed by Streptococcus
pneumoniae (22 admissions), Staphylococcus
aureus (16 admissions), and Haemophilus
influenzae (11 admissions). Thirty-three (30%) of the
pneumonias were bacteremic. Bacteremia was more common in pneumococcal
than in pseudomonal pneumonia (95% vs 9%, p < 0.0001). Compared
with patients with pneumococcal pneumonia, patients with pseudomonal
pneumonia had lower leukocyte and CD4+ lymphocyte counts, longer
hospital stay, and similar case-fatality rate.
Conclusions:P aeruginosa is becoming a
common cause of both community-acquired and nosocomial bacterial
pneumonia in hospitalized patients with HIV, especially in those with
low leukocyte and CD4+ lymphocyte counts.