Bacterial Pneumonia in Hospitalized Patients With HIV Infection: The Pulmonary Complications, ICU Support, and Prognostic Factors of Hospitalized Patients With HIV (PIP) Study

doi:10.1378/chest.117.4.1017

Chest

Volume 117, Issue 4, April 2000, Pages 1017-1022

https://doi.org/10.1378/chest.117.4.1017 Get rights and content

Study objectives

To describe the causative organisms and factors associated with bacterial pneumonia and to assess its impact on the outcome of hospitalized patients with HIV.

Design

Prospective, observational.

Setting

A university-affiliated medical center.

Methods

We included 1,225 consecutive hospital admissions, from April 1995 through March 1998, of 599 adults with HIV. We collected data on APACHE II (acute physiology and chronic health evaluation II) score, leukocyte and CD4+ lymphocyte counts, length of hospital stay, ICU admission rate, and case-fatality rate. Chest radiographs and laboratory results were reviewed. The presence of bacterial pneumonia was noted.

Results

Bacterial pneumonia was diagnosed in 111 hospitalizations (9%): 80 (72%) were community-acquired infections. The CD4+ lymphocyte count was lower (median, 38 vs 66/μL, p = 0.0027), APACHE II score higher (17 vs 13, p < 0.0001), length of hospital stay longer (median, 6 vs 4), and ICU admission (28% vs 9%) and case-fatality rates (21% vs 4%) higher in patients with bacterial pneumonia compared with those without bacterial pneumonia. The most common pathogen was Pseudomonas aeruginosa (32 admissions), followed by Streptococcus pneumoniae (22 admissions), Staphylococcus aureus (16 admissions), and Haemophilus influenzae (11 admissions). Thirty-three (30%) of the pneumonias were bacteremic. Bacteremia was more common in pneumococcal than in pseudomonal pneumonia (95% vs 9%, p < 0.0001). Compared with patients with pneumococcal pneumonia, patients with pseudomonal pneumonia had lower leukocyte and CD4+ lymphocyte counts, longer hospital stay, and similar case-fatality rate.

Conclusions

P aeruginosa is becoming a common cause of both community-acquired and nosocomial bacterial pneumonia in hospitalized patients with HIV, especially in those with low leukocyte and CD4+ lymphocyte counts.

Section snippets

Materials and Methods

This prospective, observational study included 1,225 consecutive hospital admissions of 599 adults with HIV infection treated at the University Medical Center, Jacksonville, FL, from April 1995 through March 1998. All adults with HIV infection who were admitted to the hospital were included in the study. The University Medical Center is a 528-bed, teaching inner-city hospital affiliated with the University of Florida. The need for informed consent was waived by the Institutional Review Board of

Results

The demographic characteristics, exposure categories, CD4+ lymphocyte count, and APACHE II scores of the patients are listed in Table 1 .

One hundred eleven of the 1,225 patient-admissions (9%) had bacterial pneumonia: 80 (72%) community-acquired and 31 (28%) nosocomial. The 111 episodes of bacterial pneumonia occurred in 94 patients: one episode in 82 patients, two episodes in 10 patients, three episodes in 1 patient, and six episodes in 1 patient. The causative organisms are listed in Table 2

Discussion

This study describes 111 cases of bacterial pneumonia among 1,225 hospital admissions of 599 patients with HIV infection. P aeruginosa and S pneumoniae were the two most common causative pathogens.

Early in the HIV epidemic, researchers noted that bacterial pneumonia was a common cause of morbidity.7, 8⁹ Decreasing CD4+ lymphocyte count, injection drug use, prior sinusitis, and prior lower respiratory tract bacterial infection are risk factors for bacterial pneumonia in patients with HIV

ACKNOWLEDGMENT

We thank Dr. David L. Armbruster for editing our manuscript.

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Chest

Clinical InvestigationsHIVBacterial Pneumonia in Hospitalized Patients With HIV Infection: The Pulmonary Complications, ICU Support, and Prognostic Factors of Hospitalized Patients With HIV (PIP) Study

Study objectives

Design

Setting

Methods

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

ACKNOWLEDGMENT

Am J Med

Chest

Int J Infect Dis

Pneumococcal disease during HIV infection: epidemiologic, clinical, and immunologic perspectives

Ann Intern Med

Abnormalities of B-cell activation and immunoregulation in patients with the acquired immunodeficiency syndrome

N Engl J Med

B-cell immune deficiency syndrome

JAMA

Respiratory illness in persons with human immunodeficiency virus infection

Am Rev Respir Dis

Bacterial pneumonia in patients infected with human immunodeficiency virus

N Engl J Med

Diagnosing HIV-related disease. using CD4 count as a guide

J Gen Intern Med

Streptococcus pneumoniae infection and bacteremia in patients with acquired immune deficiency syndrome with report of pneumococcal vaccine failure

Am Rev Respir Dis

Bacterial pneumonia in patients with acquired immunodeficiency syndrome

Ann Intern Med

Respiratory disease trends in the pulmonary complications of HIV Infection Study Cohort

Am J Respir Crit Care Med

Pyogenic bacterial pneumonia in human immunodeficiency virus-infected inpatients: a clinical, radiological, microbiological, and epidemiological study

Clin Infect Dis

Bacterial pneumonia in HIV-infected patients: analysis of risk factors and prognostic indicators

J Acquir Immune Defic Syndr Hum Retrovirol

Clinical Investigations
HIV
Bacterial Pneumonia in Hospitalized Patients With HIV Infection: The Pulmonary Complications, ICU Support, and Prognostic Factors of Hospitalized Patients With HIV (PIP) Study