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2118. Heathcare-Associated Infection in Intensive Care Patients Infected and Non-infected by Human Immunodefficiency Virus

BACKGROUND: Healthcare-associated infections (HAI) are related with high mortality and emergence of multidrug-resistant (MDR) organisms, mainly in critical care patients. Human immunodeficiency virus (HIV) infection is a frequent cause of intensive care unit (ICU) admission, but data about HAI in th...

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Autores principales: Castro-Lima, Victor, Borges, Igor, Joelsons, Daniel, Sales, Vivian, Guimarães, Thaís, Li, Ho Yeh, Costa, Silvia, Moura, Maria Luisa Do Nascimento
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254113/
http://dx.doi.org/10.1093/ofid/ofy210.1774
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author Castro-Lima, Victor
Borges, Igor
Joelsons, Daniel
Sales, Vivian
Guimarães, Thaís
Li, Ho Yeh
Costa, Silvia
Moura, Maria Luisa Do Nascimento
author_facet Castro-Lima, Victor
Borges, Igor
Joelsons, Daniel
Sales, Vivian
Guimarães, Thaís
Li, Ho Yeh
Costa, Silvia
Moura, Maria Luisa Do Nascimento
author_sort Castro-Lima, Victor
collection PubMed
description BACKGROUND: Healthcare-associated infections (HAI) are related with high mortality and emergence of multidrug-resistant (MDR) organisms, mainly in critical care patients. Human immunodeficiency virus (HIV) infection is a frequent cause of intensive care unit (ICU) admission, but data about HAI in this population is scarce. We aimed to evaluate HAI mortality in patients infected and non-infected by HIV in an ICU in a Brazilian public hospital and describe their epidemiological and microbiological characteristics. METHODS: This retrospective cohort included patients admitted in an Infectious Diseases ICU from July 2013 to December 2017 who acquired HAI. A database was created using SPSS and multivariate analysis was performed. Primary outcome was 30-day mortality after onset of infection. Secondary outcomes were infection caused by MDR organisms and device-associated HAI. RESULTS: During the study period, 77 ICU-patients (25 HIV and 52 non-HIV) acquired 106 HAI. HIV-patients were younger than non-HIV (45 vs. 58 years old, P = 0.002) and had more respiratory distress at admission (60.0% vs. 34.6%, P = 0.035). There was a high 30-day mortality and no difference among groups (HIV 52.0% vs. non-HIV 54.9%, P = 0.812), which was confirmed after adjusting for age, sequential organ failure assessment (SOFA) score in the day of HAI, MDR infection and more than one HAI. Central-line associated bloodstream infections (CLA-BSI) was the most frequent HAI in general population (39.6%), moreover, ventilator-associated pneumonia (VAP) was more frequent in HIV group (45.2% vs. 26.7%, P = 0.063), with similar period of invasive devices. Enterococcus faecalis was the most frequent cause of CLA-BSI in HIV group (30.0%), while Klebsiella pneumoniae was in non-HIV group (28.1%). Acinetobacter baumannii and K. pneumoniae (each 35.7%) were the predominant agents of VAP in HIV group, as Pseudomonas aeruginosa (35.0%) was in non-HIV group. Although there was a high frequency of HAI caused by MDR organisms, there was no difference among the groups (HIV 77.8% vs. non-HIV 64.3%, P = 0.214). CONCLUSION: HIV was not associated with higher mortality in critical care patients who acquired HAI. VAP was more frequent in HIV patients, probably due to higher prevalence of respiratory conditions at admission. Infection by HIV does not increase the chance to acquire an HAI by MDR organism. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-62541132018-11-28 2118. Heathcare-Associated Infection in Intensive Care Patients Infected and Non-infected by Human Immunodefficiency Virus Castro-Lima, Victor Borges, Igor Joelsons, Daniel Sales, Vivian Guimarães, Thaís Li, Ho Yeh Costa, Silvia Moura, Maria Luisa Do Nascimento Open Forum Infect Dis Abstracts BACKGROUND: Healthcare-associated infections (HAI) are related with high mortality and emergence of multidrug-resistant (MDR) organisms, mainly in critical care patients. Human immunodeficiency virus (HIV) infection is a frequent cause of intensive care unit (ICU) admission, but data about HAI in this population is scarce. We aimed to evaluate HAI mortality in patients infected and non-infected by HIV in an ICU in a Brazilian public hospital and describe their epidemiological and microbiological characteristics. METHODS: This retrospective cohort included patients admitted in an Infectious Diseases ICU from July 2013 to December 2017 who acquired HAI. A database was created using SPSS and multivariate analysis was performed. Primary outcome was 30-day mortality after onset of infection. Secondary outcomes were infection caused by MDR organisms and device-associated HAI. RESULTS: During the study period, 77 ICU-patients (25 HIV and 52 non-HIV) acquired 106 HAI. HIV-patients were younger than non-HIV (45 vs. 58 years old, P = 0.002) and had more respiratory distress at admission (60.0% vs. 34.6%, P = 0.035). There was a high 30-day mortality and no difference among groups (HIV 52.0% vs. non-HIV 54.9%, P = 0.812), which was confirmed after adjusting for age, sequential organ failure assessment (SOFA) score in the day of HAI, MDR infection and more than one HAI. Central-line associated bloodstream infections (CLA-BSI) was the most frequent HAI in general population (39.6%), moreover, ventilator-associated pneumonia (VAP) was more frequent in HIV group (45.2% vs. 26.7%, P = 0.063), with similar period of invasive devices. Enterococcus faecalis was the most frequent cause of CLA-BSI in HIV group (30.0%), while Klebsiella pneumoniae was in non-HIV group (28.1%). Acinetobacter baumannii and K. pneumoniae (each 35.7%) were the predominant agents of VAP in HIV group, as Pseudomonas aeruginosa (35.0%) was in non-HIV group. Although there was a high frequency of HAI caused by MDR organisms, there was no difference among the groups (HIV 77.8% vs. non-HIV 64.3%, P = 0.214). CONCLUSION: HIV was not associated with higher mortality in critical care patients who acquired HAI. VAP was more frequent in HIV patients, probably due to higher prevalence of respiratory conditions at admission. Infection by HIV does not increase the chance to acquire an HAI by MDR organism. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6254113/ http://dx.doi.org/10.1093/ofid/ofy210.1774 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Castro-Lima, Victor
Borges, Igor
Joelsons, Daniel
Sales, Vivian
Guimarães, Thaís
Li, Ho Yeh
Costa, Silvia
Moura, Maria Luisa Do Nascimento
2118. Heathcare-Associated Infection in Intensive Care Patients Infected and Non-infected by Human Immunodefficiency Virus
title 2118. Heathcare-Associated Infection in Intensive Care Patients Infected and Non-infected by Human Immunodefficiency Virus
title_full 2118. Heathcare-Associated Infection in Intensive Care Patients Infected and Non-infected by Human Immunodefficiency Virus
title_fullStr 2118. Heathcare-Associated Infection in Intensive Care Patients Infected and Non-infected by Human Immunodefficiency Virus
title_full_unstemmed 2118. Heathcare-Associated Infection in Intensive Care Patients Infected and Non-infected by Human Immunodefficiency Virus
title_short 2118. Heathcare-Associated Infection in Intensive Care Patients Infected and Non-infected by Human Immunodefficiency Virus
title_sort 2118. heathcare-associated infection in intensive care patients infected and non-infected by human immunodefficiency virus
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254113/
http://dx.doi.org/10.1093/ofid/ofy210.1774
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