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Ye H, Su FF, Cui XY, Guo XX, Zhu TY, Kong DY, Miao XG. Evaluation of Different Blood Culture Bottles for the Diagnosis of Bloodstream Infections in Patients with HIV. Infect Dis Ther 2023; 12:2611-2620. [PMID: 37870693 PMCID: PMC10651575 DOI: 10.1007/s40121-023-00883-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/03/2023] [Indexed: 10/24/2023] Open
Abstract
INTRODUCTION Bloodstream infection (BSI) is a significant factor contributing to hospitalization and high mortality rates among human immunodeficiency virus(HIV)-positive patients. Therefore, the timely detection of this condition is of utmost importance. Blood culture is considered the gold standard for diagnosing BSIs. Currently, BD BACTEC™ Plus Aerobic/F culture bottles and the BD BACTEC™ Myco/F Lytic culture bottles can be used for blood culture. This study aimed to evaluate the efficacy of two different types of culture bottles in diagnosing BSIs in patients with HIV. METHODS A retrospective analysis was conducted on HIV-positive patients hospitalized in the Infection Department of Wenzhou Central Hospital between July 2019 and October 2021. A total of 246 pairs of blood samples were included, consisting of an aerobic culture vial and a Myco/F culture vial. Blood culture results and clinical diagnosis were utilized to identify the presence of BSI. RESULTS Out of 246 cases, 84 cases had positive blood cultures. Fungal BSIs, particularly Talaromyces marneffei BSIs, were the most prevalent among patients with HIV. The positive rate of Myco/F culture bottles (89.29%) was significantly higher compared with aerobic culture bottles (69.05%; P = 0.001). In the diagnosis of fungal BSIs, the positive rate of Myco/F culture bottles was 88.57%, which was significantly higher than that of aerobic culture bottles (72.86%; P = 0.018). The Myco/F culture bottle has more advantages in diagnosing Talaromyces marneffei BSIs (P=0.028). In addition, mycobacteria were exclusively detected in Myco/F culture bottles. CONCLUSIONS Fungal BSIs are the predominant type of infections in HIV-positive patients. Myco/F culture bottles exhibit noteworthy attributes of high positive rate in diagnosing HIV combined with BSI. These advantages are conducive to obtaining accurate culture results and minimizing missed diagnoses.
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Affiliation(s)
- Hui Ye
- Department of Infectious Diseases, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, The Second Affiliated Hospital of Shanghai University, Zhejiang, 325000, China
- Department of Infectious Diseases, The Sixth People's Hospital of Wenzhou, Nanbaixiang Street, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China
| | - Fei-Fei Su
- Department of Infectious Diseases, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, The Second Affiliated Hospital of Shanghai University, Zhejiang, 325000, China
- Department of Infectious Diseases, The Sixth People's Hospital of Wenzhou, Nanbaixiang Street, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China
| | - Xiao-Ya Cui
- Department of Infectious Diseases, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, The Second Affiliated Hospital of Shanghai University, Zhejiang, 325000, China
- Department of Infectious Diseases, The Sixth People's Hospital of Wenzhou, Nanbaixiang Street, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China
| | - Xiu-Xiu Guo
- Department of Infectious Diseases, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, The Second Affiliated Hospital of Shanghai University, Zhejiang, 325000, China
- Department of Infectious Diseases, The Sixth People's Hospital of Wenzhou, Nanbaixiang Street, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China
| | - Tian-Ye Zhu
- Department of Infectious Diseases, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, The Second Affiliated Hospital of Shanghai University, Zhejiang, 325000, China
- Department of Infectious Diseases, The Sixth People's Hospital of Wenzhou, Nanbaixiang Street, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China
| | - De-Yong Kong
- Department of Infectious Diseases, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, The Second Affiliated Hospital of Shanghai University, Zhejiang, 325000, China
- Department of Infectious Diseases, The Sixth People's Hospital of Wenzhou, Nanbaixiang Street, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China
| | - Xing-Guo Miao
- Department of Infectious Diseases, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, The Second Affiliated Hospital of Shanghai University, Zhejiang, 325000, China.
- Department of Infectious Diseases, The Sixth People's Hospital of Wenzhou, Nanbaixiang Street, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China.
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Lai J, Liu Y, Ye H, Chen Y. Talaromyces marneffei is the Persistent Overwhelming Bloodstream Infection Pathogen Among HIV Inpatients in Fujian, China. Infect Drug Resist 2022; 15:5207-5214. [PMID: 36090604 PMCID: PMC9462516 DOI: 10.2147/idr.s379100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to investigate the epidemiology and etiological spectrums of BSI in Fujian over the past 6 years in the post antiretroviral treatment (ART) era. Methods A retrospective, observational study was conducted to include positive BSI inpatients with HIV between September 2015 and August 2021 in Mengchao Hepatobiliary Hospital of Fujian Medical University, the largest designated HIV/AIDS care hospital in Fujian, China. Demographic data and laboratory data including gender, age, blood cell counts, biochemistry results, CD4 and CD8 cell counts, HIV-RNA loads, pathogen isolates, procalcitonin (PCT) levels and c-reactive protein (CRP) levels were collected. Continuous variables were expressed as median (range) and Kruskal–Wallis or Mann–Whitney test was used to analyze the differences between groups. Categorical data were expressed as numbers (percentage) and the differences between groups were analyzed by Pearson’s chi-squared test. Results In total, 3681 HIV inpatients with blood culture data were included and 683 strains identified from 646 inpatients were further analyzed. The median age of patients was 38 years and male accounted for 86.84%. The pooled prevalence of BSI was 18.55% (12.01%–22.36% during the six-year period). The overall isolated rate of Talaromyces marneffei (TM) in blood culture was 12.42% (8.3%–15.00% during the study period). TM was the persistent dominant BSI pathogen from 2015 to 2021 (accounting for 63.04% to 71.43%), followed by Cryptococcus neoformans (responsible for 10.00% to 20.83%). Compared to patients with other organisms BSI, those with TM BSI were younger and had lower CD4 counts, WBC counts, HB and CRP level, but higher HIVRNA loads. Conclusion BSI is still a major problem in the post ART era in hospitalized patients with HIV/AIDS in Fujian, China. TM is the predominant pathogen. This underlines the importance of an early diagnosis of opportunistic pathogen to avoid BSI in HIV-infected populations with a low immune status.
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Affiliation(s)
- Jinglan Lai
- Department of Infectious Diseases, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Yuming Liu
- Department of Anesthesiology, MengChao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Hanhui Ye
- Department of Infectious Diseases, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Yahong Chen
- Department of Infectious Diseases, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, People's Republic of China
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Lang R, Gill MJ, Viczko J, Naugler C, Church D. Risk Factors and Outcomes of Bloodstream Infections Among People With Human Immunodeficiency Virus: A Longitudinal Cohort Study From 2000 to 2017. Open Forum Infect Dis 2022; 9:ofac318. [PMID: 35937645 PMCID: PMC9346145 DOI: 10.1093/ofid/ofac318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Indexed: 11/14/2022] Open
Abstract
Background Bloodstream infections (BSIs) among people with human immunodeficiency virus (PWH) remain a poorly studied source of morbidity and mortality. We characterize the epidemiology, microbiology, and clinical outcomes including reinfection, hospitalization, and mortality rates of both community-acquired and hospital-acquired BSI in PWH. Methods We identified all BSI, between January 1, 2000 and December 31, 2017 in PWH in care at Southern Alberta Clinic, by linking data from laboratory and clinical databases. Crude incidence rates per 1000 person-years for BSI and death were calculated. Cox proportional hazards models estimated crude and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) to conduct a risk factor analysis of BSI in PWH. Logistic regression models with generalized estimating equations estimated crude and adjusted odds ratios (aORs) to identify characteristics associated with 1-year mortality after BSI. Results Among 2895 PWH, 396 BSI episodes occurred in 228 (8%) PWH. There were 278 (72%) Gram-positive and 109 (28%) Gram-negative BSI. People with human immunodeficiency virus with lower CD4 nadirs, higher Charlson comorbidity indices, and hepatitis C virus were at highest risk for BSI. Long-term all-cause mortality was greater in those experiencing BSI (HR, 5.25; 95% CI, 4.21-6.55). CD4 count <200 cells/mm3 measured closest to the time of BSI was associated with 1-year mortality after BSI (aOR, 3.88; 95% CI, 1.78-8.46). Repeat episodes (42%) and polymicrobial BSI (19%) were common. Conclusions Bloodstream infections continue to occur at an elevated rate among PWH with high reoccurrence rates and associated morbidity and mortality. To risk stratify and develop targeted interventions, we identified PWH at greatest risk for BSI. People with human immunodeficiency virus with low immunity at the time of BSI are at highest risk of poor outcomes.
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Affiliation(s)
- Raynell Lang
- Correspondence: Raynell Lang, MD MSc, Department of Medicine 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N4N1 ()
| | - M John Gill
- Southern Alberta HIV Clinic, Alberta Health Services, Calgary, AlbertaCanada,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AlbertaCanada
| | - Jeannine Viczko
- Department of Pathology & Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AlbertaCanada
| | - Christopher Naugler
- Departments of Pathology & Laboratory Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AlbertaCanada
| | - Deirdre Church
- Departments of Medicine and Pathology & Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AlbertaCanada,Calgary Laboratory Services, Alberta Health Services, Calgary, AlbertaCanada
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Marques CDC, Silva BCOD, Barreto VP, Feitoza AR, Lira ALBDC, Feijão AR. Accuracy of risk factors for nursing diagnosis risk of infection in people with AIDS. Rev Esc Enferm USP 2021; 55:e20200309. [PMID: 34477196 DOI: 10.1590/1980-220x-reeusp-2020-0309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/24/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the accuracy of risk factors for infection that add up to the nursing diagnosis risk of infection in people with AIDS who are hospitalized. METHOD Accuracy study with case-control design carried out with a total of 208 people living with AIDS and hospitalized between 2010 and 2016. The cases comprised people living with HIV, hospitalized and who developed infection related to health care and controls to those who did not develop it. Secondary data from medical records and research forms were used to respond to the data collection instrument for sociodemographic, clinical evaluation and investigation of the presence or absence of risk factors. The accuracy of clinical diagnostic indicators was measured through specificity, sensitivity and predictive values. RESULTS The risk factor that showed the greatest sensitivity and specificity was chronic illness, while the invasive procedure and the change in the integrity of the skin had the highest positive predictive value. CONCLUSION Accurate diagnoses allow nurses to build a nursing intervention plan aimed at the needs of this population.
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Affiliation(s)
| | | | - Vanessa Pinheiro Barreto
- Universidade Federal do Rio Grande do Norte, Programa de Pós-Graduação em Enfermagem, Natal, RN, Brazil
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De Matos A, Lopes SB, Serra JE, Ferreira E, da Cunha JS. Mortality predictive factors of people living with human immunodeficiency virus and bloodstream infection. Int J Infect Dis 2021; 110:195-203. [PMID: 34161800 DOI: 10.1016/j.ijid.2021.06.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Portugal has one of the highest mortality rates for people living with HIV (PLWHIV) in Europe. After antiretroviral therapy introduction, HIV-associated mortality declined, included the one associated with bloodstream infection (BSI). However it is still high, and European data are scarce . Therefore, characterizing BSI and defining prognostic factors may improve our approach. METHODS This was a 10-year retrospective study of predictive factors for 30-day and 3-year mortality in PLWHIV with BSI in a tertiary infectious diseases ward. RESULTS Of 2134 PLWHIV admissions, 145 (6.8%) had a BSI, mostly respiratory and catheter-related bacteremia and globally community-acquired. Nosocomial infections occurred in 42 (36%) cases, mostly caused by Enterococcus spp, Staphylococcus aureus, and Candida spp. PLWHIV with a BSI had higher 30-day mortality (27%) compared to those without a BSI (14%). APACHE II score, corticotherapy, and current intravenous drug use (IDU) had a prognostic impact on 30-day mortality. Three-year survival was 54% in PLWHIV with a BSI; a CD4 <200 cells, vascular or chronic pulmonary disease, and lymphoma were prognostic factors. CONCLUSIONS Patients with a BSI were more likely to present advanced HIV disease, have more comorbidities, a longer length of stay, and higher 30-day mortality. IDU and severity of infection determined the short-term prognosis. Three-year mortality was primarily influenced by lower CD4 cell counts, hematological tumor, and cardiopulmonary comorbidities. Systemic corticotherapy may influence nosocomial BSI and short-term prognosis.
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Affiliation(s)
- Andreia De Matos
- Internal Medicine Department, Coimbra Hospital and University Center, Coimbra, Portugal.
| | - Sara Brandão Lopes
- Infectious Disease Department, Coimbra Hospital and University Center, Coimbra, Portugal.
| | - José Eduardo Serra
- Infectious Disease Department, Coimbra Hospital and University Center, Coimbra, Portugal.
| | - Eugénia Ferreira
- Infectious Disease Department, Coimbra Hospital and University Center, Coimbra, Portugal.
| | - José Saraiva da Cunha
- Infectious Disease Department, Coimbra Hospital and University Center, Coimbra, Portugal.
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Swanta N, Aryal S, Nejtek V, Shenoy S, Ghorpade A, Borgmann K. Blood-based inflammation biomarkers of neurocognitive impairment in people living with HIV. J Neurovirol 2020; 26:358-370. [PMID: 32193795 DOI: 10.1007/s13365-020-00834-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 12/21/2022]
Abstract
Inflammation in people living with HIV (PLWH) correlates with severity of HIV-associated neurocognitive disorders. The objective of this study is to identify blood-based markers of neurocognitive function in a demographic balanced cohort of PLWH. Seven neurocognitive domains were evaluated in 121 seropositive Black/African American, Non-Hispanic White, and White Hispanic men and women using computerized assessments. Associations among standardized neurocognitive function and HIV-related parameters, relevant sociodemographic variables, and inflammation-associated cytokines measured in plasma and cellular supernatants were examined using multivariate and univariate regression models. Outlier and covariate analyses were used to identify and normalize for education level, CD4 T cell count, viral load, CNS and drug abuse comorbidities, which could influence biomarker and neurocognitive function associations. Plasma levels of chemokine (C-C motif) ligand (CCL) 8 significantly associated with memory, complex attention, cognitive flexibility, psychomotor speed, executive function, and processing speed. Plasma tissue inhibitor of metalloproteinases 1 associated with the aforementioned domains except memory and processing speed. In addition, plasma interleukin-23 significantly associated with processing speed and executive function. Analysis of peripheral blood cell culture supernatants revealed no significant markers for neurocognitive function. In this cohort, CD4 T cell count and education level also significantly associated with neurocognitive function. All identified inflammatory biomarkers demonstrated a negative correlation to neurocognitive function. These cytokines have known connections to HIV pathophysiology and are potential biomarkers for neurocognitive function in PLWH with promising clinical applications.
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Affiliation(s)
- Naomi Swanta
- Department of Microbiology, Immunology and Genetics, Graduate School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Subhash Aryal
- Department of Biostatistics, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA.,Department of Gynecology Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Vicki Nejtek
- Department of Pharmacology and Neuroscience, Graduate School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Sangeeta Shenoy
- Department of Microbiology, Immunology and Genetics, Graduate School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Anuja Ghorpade
- Department of Microbiology, Immunology and Genetics, Graduate School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA.,Medical Innovation Collaborative of North Texas, Irving, TX, USA
| | - Kathleen Borgmann
- Department of Microbiology, Immunology and Genetics, Graduate School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA. .,Department of Pharmacology and Neuroscience, Graduate School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA.
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