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

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.

Mortality from Infections Associated with Health Care in Patients with HIV in Paraguay

“…CD4 is a type of white blood cell that helps the immune system fight infections. When the CD4 count is low, the immune system is weakened and more susceptible to opportunistic infections, which predisposes to HAIs, as highlighted by Castro-Lima VAC et al (6) and Rojas D (7).…”

“…Healthcare-associated infections (HAIs) are complications that increase patient morbidity and mortality, length of hospital stay, and related costs, and have a significant impact on the healthcare system (3). Few studies have evaluated HAIs in an HIV population (4,5); however, studies have suggested that patients with HIV are at an increased risk of contracting an HAI because they have high rates of hospitalization and longer hospital stays, and they are at high risk of contracting infections considering their immunosuppressed status (4)(5)(6).…”

Decrease in Incidence Rate of Hospitalizations Due to AIDS-Defining Conditions but Not to Non-AIDS Conditions in PLWHIV on cART in 2008–2018 in Italy

“…After the introduction of cART, the hospitalizations rate declined in PLWHIV, and this decline (−61.8%) was greater than the decline in age-standardized hospitalization rates observed for the general population in the same time period (−26.4%), according to the official register of Italian Health Departement. Non-AIDS-related hospitalizations were more frequent than those related to AIDS [ 2 , 6 , 7 , 8 , 9 ].…”

Coexistência de HIV não à associada a aumento da mortalidade em pacientes oncológicos internados na Unidade de Terapia Intensiva

“…A diminuição da mortalidade de indivíduos infectados pelo HIV após a introdução de terapia antirretroviral altamente ativa (TARV) [7], resultou também no crescimento e envelhecimento da população infectada pelo vírus, causando assim um aumento de casos de cânceres associados à síndrome da imunodeficiência adquirida (AIDS) [8], que constituem uma parte relevante da mortalidade atribuíveis à infecção pelo HIV [9]. [20]. Por outro lado, em pacientes com sepse, o fato de ser portador de HIV tem sido associado a maior mortalidade a curto prazo [21].…”