Epidemiology and Outcome of Bloodstream Infections in HIV-Infected Adults in the 1990s

Although improved antiretroviral therapy (ART) has reduced overall mortality and altered the natural history of HIV infection, its effect on the microbiology, epidemiology, and outcome of BSIs is not known. We compared 85 episodes of BSI in HIV-infected persons during 1997 with 81 episodes during 1992 at three university hospitals. The most common microorganisms during both periods were Staphylococcus aureus, Streptococcus pneumoniae, Enterobacteriaceae, Pseudomonas aeruginosa, and Mycobacterium avium complex. During both periods, most episodes were communityacquired (1997, 77.8%; 1992, 88.2%), and the most common sources were the respiratory tract and intravascular devices. Mortality was lower in 1997 (11.8%) than in 1992 (18.5%), but the difference was not statistically significant. In 1997, only 11/74 patients (14.9%) for whom the use of antiretroviral therapy was known were receiving HAART, and >50% of patients were receiving no ART. Consequently, the number of patients receiving HAART was too small to show differences in mortality versus those receiving only reverse transcriptase inhibitors or no ART. Despite the recognized impact of HAART on the outcome of HIV infection, its potential to alter BSIs is yet to be realized, in part because many such patients are not actually receiving ART.