Bacteremia in HIV-positive and AIDS patients: incidence, species distribution, risk-factors, outcome, and influence of long-term prophylactic antibiotic treatment.

From a cohort of 837 adult, mainly homosexual HIV-infected patients, 76 bacteremic/fungemic episodes were identified in 63 patients over a 5-year period. Compared with an age-matched reference population with an incidence of 10.3 bacteremias/10,000 person-years, the incidence was 170 among pre-AIDS (p < 0.001) and 3,200 among AIDS patients (p < 0.001). Staphylococcal infections comprised 35% of all episodes, while the HIV-related pathogens Streptococcus pneumoniae, Salmonella spp. and C. neoformans together accounted for 34%. The overall mortality associated with clinical bacteremia was 12%, but nil for Salmonella spp. and S. pneumoniae. Predisposing factors for the infection were: low CD4 count (< 100 x 10(6)/l) in 71%, permanent intravenous line, 44%; neutropenia, 11% and active intravenous drug abuse, 7%. Hence, in this population, intensified hygienic precautions for intravenous lines should be the primary target for intervention. Long-term cotrimoxazole prophylaxis may prevent bacteremia with S. pneumoniae and Salmonella spp.