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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
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.
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- Copyright © The Society for Healthcare Epidemiology of America 1997
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