Outcome and reinfection after Staphylococcus aureus bacteraemia in individuals with and without HIV-1 infection: a case–control study

TY - JOUR

T1 - Outcome and reinfection after Staphylococcus aureus bacteraemia in individuals with and without HIV-1 infection

T2 - a case–control study

AU - Stammler Jaliff, Bianca

AU - Dahl-Knudsen, Jenny

AU - Petersen, Andreas

AU - Skov, Robert

AU - Benfield, Thomas

PY - 2014

Y1 - 2014

N2 - OBJECTIVES: Individuals infected with HIV-1 are at an increased risk of Staphylococcus aureus bacteraemia (SAB). The aim of this study was to investigate mortality rate and risk of reinfection associated with SAB in HIV-1-infected individuals compared to individuals without HIV-1 infection.SETTING: University hospital treating a third of the estimated 5000 individuals with HIV infection in Denmark.PARTICIPANTS: HIV-1-infected (n=82) and sex-matched and age-matched uninfected (n=163) individuals with SAB in the time period 1 January 1995 to 31 December 2010.PRIMARY OUTCOME MEASURES: 30-day and 365-day mortality rate ratio and relative risk of reinfection.RESULTS: Individuals with HIV had an increased risk of death at day 30 (OR 11.90 (95% CI 2.15 to 65.85)) compared to individuals without HIV. Other factors associated with mortality were age, a foreign device and Pitt score. HIV-related factors did not associate to mortality. During follow-up, there were 43 episodes of reinfection; in individuals with HIV infection at an incidence rate of 7.8 (95% CI 4.7 to 10.9)/100 person-years compared with 2.2 (95% CI 1.2 to 3.2)/100 person-years for individuals without HIV. In multivariate analysis, HIV status (OR 2.91 (95% CI 1.29 to 6.58) and injection drug use (OR 3.51 (95% CI 1.06 to 11.63) were independently associated with an increased risk of reinfection.CONCLUSIONS: HIV-1 infection is associated with an increased risk of 30-day mortality after SAB and a very high rate of reinfection. Age, a foreign device and Pitt score predicted outcome. For patients infected with HIV, neither CD4 T-lymphocyte counts nor plasma HIV RNA levels were associated with 30-day outcome.TRIAL REGISTRATION NUMBER: The study was approved by the Danish Data Protection Agency (record no. 2007-41-1196).

AB - OBJECTIVES: Individuals infected with HIV-1 are at an increased risk of Staphylococcus aureus bacteraemia (SAB). The aim of this study was to investigate mortality rate and risk of reinfection associated with SAB in HIV-1-infected individuals compared to individuals without HIV-1 infection.SETTING: University hospital treating a third of the estimated 5000 individuals with HIV infection in Denmark.PARTICIPANTS: HIV-1-infected (n=82) and sex-matched and age-matched uninfected (n=163) individuals with SAB in the time period 1 January 1995 to 31 December 2010.PRIMARY OUTCOME MEASURES: 30-day and 365-day mortality rate ratio and relative risk of reinfection.RESULTS: Individuals with HIV had an increased risk of death at day 30 (OR 11.90 (95% CI 2.15 to 65.85)) compared to individuals without HIV. Other factors associated with mortality were age, a foreign device and Pitt score. HIV-related factors did not associate to mortality. During follow-up, there were 43 episodes of reinfection; in individuals with HIV infection at an incidence rate of 7.8 (95% CI 4.7 to 10.9)/100 person-years compared with 2.2 (95% CI 1.2 to 3.2)/100 person-years for individuals without HIV. In multivariate analysis, HIV status (OR 2.91 (95% CI 1.29 to 6.58) and injection drug use (OR 3.51 (95% CI 1.06 to 11.63) were independently associated with an increased risk of reinfection.CONCLUSIONS: HIV-1 infection is associated with an increased risk of 30-day mortality after SAB and a very high rate of reinfection. Age, a foreign device and Pitt score predicted outcome. For patients infected with HIV, neither CD4 T-lymphocyte counts nor plasma HIV RNA levels were associated with 30-day outcome.TRIAL REGISTRATION NUMBER: The study was approved by the Danish Data Protection Agency (record no. 2007-41-1196).

U2 - 10.1136/bmjopen-2013-004075

DO - 10.1136/bmjopen-2013-004075

M3 - Journal article

C2 - 24760348

SN - 2044-6055

VL - 4

SP - 1

EP - 6

JO - BMJ Open

JF - BMJ Open

IS - 4

M1 - e004075

ER -