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Nosocomial Infections in HIV-Infected Patients Preliminary Results from a Multicenter Surveillance System (1989-1995)

Published online by Cambridge University Press:  02 January 2015

Leonardo Stroud ,
Pamela Srivastava ,
David Culver ,
Alan Bisno ,
David Rimland ,
Michael Simberkoff ,
Harvey Elder ,
Joshua Fierer ,
William Martone  and
Robert Gaynes
Leonardo Stroud*
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Pamela Srivastava
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
David Culver
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Alan Bisno
Affiliation:
Division of Infectious Diseases, Department of Medicine, Miami Veterans' Affairs Medical Center, Miami, Florida
David Rimland
Affiliation:
Division of Infectious Diseases, Department of Medicine, Atlanta Veterans' Affairs Medical Center and Georgia Research Center on AIDS and HIV Infection, Atlanta, Georgia
Michael Simberkoff
Affiliation:
Division of Infectious Diseases, Department of Medicine, New York Veterans' Affairs Medical Center, New York, New York
Harvey Elder
Affiliation:
Infectious Disease Section, Medicine Service, Pettis Memorial Veterans' Affairs Medical Center, Loma Linda, California
Joshua Fierer
Affiliation:
Division of Infectious Diseases, Department of Medicine, San Diego Veterans' Affairs Medical Center, San Diego, California
William Martone
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Robert Gaynes
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Mailstop E-55, Hospital Infections Program, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333
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Abstract

Objective:

To describe the characteristics of and trends in nosocomial infection among human immunodeficiency virus (HIV)-infected patients.

Design:

Multicenter prospective cohort study.

Setting/Patients:

HIV-infected patients were enrolled at time of first inpatient admission at five Veterans' Administration Medical Centers (VAMCs).

Results:

As of March 1995, 2,541 patients with 6,625 inpatient admissions had been monitored in the five VAMCs. A total of 530 nosocomial infections were detected using standard Centers for Disease Control and Prevention definitions. Overall distribution by infection site was 31% for primary bloodstream infections (BSIs), 28% for urinary tract infections, 15% for pneumonia, and 26% for all other sites. Of BSIs, 63% were central line-associated bloodstream infections (CLABs). The rate of CLABs per 1,000 central line days was 6.5 (range, 2.3-8.3) for all patients from participating hospitals, similar to the median CLAB rate of 6.0 for patients in medical intensive-care units (ICUs) of National Nosocomial Infections Surveillance (NNIS) System hospitals from January 1990 through September 1994. For ICU-specific CLABs, the rate from hospitals reporting at least one ICU CLAB was 12.7 (range, 12.1-13.1), comparable to the 90th percentile of NNIS hospital medical ICUs (13.1). Staphylococcus aureus, associated with 35% of BSIs, was the most common nosocomial BSI pathogen. Our data demonstrated the following: 13 (10%) of 134 patients with CD4 counts ≥200 cells/mm3 had a CLAB, compared with 61 (6%) of 1,011 patients with CD4 counts <200 cells/mm3, P=.08; the per-day risk of CLABs did not change with increased duration of catheterization (P=.4); and the per-day risk of a temporary (ie, short-term) CLAB was greater than that of a permanent CLAB (P<.001).

Conclusions:

The data suggest that HIV-infected patients were at higher risk of acquiring a BSI than were patients in the NNIS population; patients with CD4 counts ≥200 cell/mm3 and temporary central lines were at increased risk for BSI, perhaps reflecting widespread prophylaxis with trimethoprim-sulfamethoxazole among patients with CD4 counts <200 cells/mm3; and, in contrast to most studies, S aureus, not coagulase-negative Staphylococcus, was the most common BSI pathogen.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 7 , July 1997 , pp. 479 - 485
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

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