AIDS 2000, 14 (Supplement 4):S132
The following abstract was omitted from the book of abstracts of the Fifth International Congress on Drug Therapy in HIV Infection, 22-26 October 2000, Glasgow (in AIDS Volume 14 Supplement 4, October 2000). The text below replaces the second abstract published under Poster 399, which was a replication of Poster 312.
P399A ten-year survey of enterococcal disease complicating HIV infectionR. Manfredi1, A. Nanetti2, R. Valentini2and F. Chiodo11Department of Clinical and Experimental Medicine, Division of Infectious Diseases and 2Division of Microbiology, University of Bologna, S. Orsola Hospital, Bologna, ItalyThe clinical role of Enterococcus spp. infection in the setting of HIV disease is still poorly defined.Clinical and microbiological records of 2224 consecutive HIV-infected patients followed since 1991 were reviewed, in order to assess all episodes of Enterococcus spp. disease according to several epidemiological, clinical, laboratory, and therapeutic features.One hundred and 48 disease episodes were documented in 121 patients (5.4%) aged 2-62 years; only 12 cases occurred since 1998. E. faecalis was the most frequent bacterial isolate (128 cases: 86.5%), followed by E. faecium (7), and group D streptococci (13); 42.6% of episodes had a polymicrobial origin. One hundred and 12 episodes (75.7%) interested the urinary tract, while sepsis and other localizations accounted for 30 and 6 cases, respectively. Significant risk factors supporting enterococcal infection were: stage C HIV disease (P < 0.01), a CD4+ lymphocyte count < 100/μl (P < 0.005), neurogenic bladder or altered mentation (P < 0.04), hospitalisation since ≥ 72 hours (P < 0.01), urinary catheterization (P < 0.01), and prior use of broad-spectrum antibiotics or cotrimoxazole (P < 0.05), while no significant difference was seen according to age, gender, and type of exposure to HIV infection. The occurrence of sepsis proved significantly related to a prior or concurrent diagnosis of AIDS (P < 0.001), a CD4+ cell count < 50/μl (P < 0.002), and an absolute neutrophil count < 1000/μl (P < 0.05). A favourable susceptibility to glycopeptides (100% of strains), penicillin (> 93%), ampicillin and piperacillin (> 98%) was found, while > 33% of bacterial isolates proved resistant to clindamycin, macrolides and chloramphenicol, and > 80% to tetracyclines. Antibiotic therapy (performed with semisynthetic penicillins in > 65% of cases, and glycopeptides or associated antimicrobial compounds in the remaining episodes), led to clinical and microbiological cure in 5-18 days, but 20 patients (16.5%), suffered from one or more disease relapses, diagnosed after 3-12 weeks. In 5 subjects only (4.1%), with a far advanced underlying disease, E. faecalis sepsis contributed to death. Enterococcus spp. organisms may express a pathogenic potential greater than that previously estimated in HIV-infected patients. Although a limited antibiotic resistance profile was found in our isolates, hospitalised patients with AIDS, neurological disorders, severe immunodeficiency, instrumentation, and prior antimicrobial use, are at increased risk of potentially life-threatening Enterococcus spp. disease.
© 2000 Lippincott Williams & Wilkins, Inc.