Pseudomonas organisms other than Pseudomonas aeruginosa as emerging bacterial pathogens in patients with human immunodeficiency virus infection

Citation
R. Manfredi et al., Pseudomonas organisms other than Pseudomonas aeruginosa as emerging bacterial pathogens in patients with human immunodeficiency virus infection, INF DIS C P, 9(2), 2000, pp. 79-87
Citations number
53
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Clinical Immunolgy & Infectious Disease
Journal title
INFECTIOUS DISEASES IN CLINICAL PRACTICE
ISSN journal
1056-9103 → ACNP
Volume
9
Issue
2
Year of publication
2000
Pages
79 - 87
Database
ISI
SICI code
1056-9103(200002)9:2<79:POOTPA>2.0.ZU;2-5
Abstract
To evaluate the clinical and microbiologic profile of non-aeruginosa Pseudo monas infections in patients hospitalized for human immunodeficiency virus (HIV) disease complications, 64 episodes of non-aeruginosa Pseudomonas spec ies complications diagnosed in 59 HIV-infected patients were retrospectivel y reviewed. Non-aeruginosa Pseudomonas infection involved mostly lower airw ays (24 cases), urinary tract (21 episodes), and blood (15 cases), with P. (renamed Burkholderia) cepacia isolated in 14 episodes, P. putida and P. fl uorescens in nine each, P. diminuta in six, P. stutzeri in five, P. vesicul aris in four, and unspeciated Pseudomonas species in the remaining 17. All patients had advanced HIV disease, as demonstrated by low mean CD4 lymphocy te counts (57.9 +/- 21.2 cells/mu L), whereas an absolute neutrophil count of less than 1000 cells/mu L was disclosed in 18 of 64 episodes. The freque ncy of full-blown AIDS and the severity of immunodeficiency were greater in patients who developed septicemia (15 episodes on the whole, 12 of them oc curring in patients with AIDS). More than 60% of patients were given antibi otics or cotrimoxazole in the month preceding disease onset, whereas intrav ascular and urinary catheters were associated with bacteremia and urinary t ract involvement, respectively, in a minority of cases. Seventy percent of episodes were hospital-acquired and proved to be significantly related to a diagnosis of AIDS, neutropenia, the occurrence of sepsis or urinary tract infection, and prior antibiotic use. Favorable sensitivity levels to ureido penicillins, ceftazidime, imipenem, ciprofloxacin, and most aminoglycosides were observed. Clinical and microbiologic cure was obtained in 91.5% of pa tients at the first episode and in 6.8% more patients after a relapse, wher eas only one patient with multiple AIDS-related disorders died of nosocomia l P. cepacia septicemia (leading to a case-fatality rate of 1.7% only). Our experience emphasizes that non-aeruginosa Pseudomonas organisms may cause morbidity among HIV-infected individuals and should be carefully considered by clinicians and microbiologists involved in the care of these patients, even when some presumptive risk factors are lacking.