An analysis of bacteraemias in HIV-1 infected adults A Bryce1*, J P Skittrall2, Y Gilleece1 and C Sargent1 1Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BE, UK 2Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK; current address: West Suffolk NHS Foundation Trust, Hardwick Lane, Bury St Edmunds, IP33 2QZ, UK *[email protected]

Introduction and Purpose •Streptococcus pneumoniae, Klebsiella pneumoniae Conclusions •cART has decreased the risk of overwhelming and Escherichia coli were the most common •Blood stream infections are much less common opportunistic infection in those with HIV. organisms (3/26 infections each; see Figure 1). amongst our cohort than in reports prior to or •Previous studies still suggest increased morbidity earlier in the cART era. •Respiratory infections were the most frequent and mortality from invasive bloodstream infection •Respiratory pathogens (particularly Streptococcus anatomical source of blood stream infection (8/26 in those with HIV compared with those without.1,2 pneumoniae) remain a significant cause of infections). •Previous studies also suggest different organisms morbidity and mortality in this cohort. •Those with soft tissue and respiratory infections account for bloodstream infection in those with •Haematological malignancy is implicated in a tended to stay longer in hospital; those with urine HIV3 – suggesting irreversible immunomodulation disproportionate number of bacteraemias in this and venous catheter infections tended to stay for even amongst those on cART.4 Figure 2. Mean length of stay by primary site of infection. cohort. less long in hospital (see Figure 2). •Many studies of bacteraemia in HIV-positive Error bars represent ±1 standard error. The blue line •Current understanding of bacteraemias in HIV-1 •Those with Streptococcus pneumoniae infection shows the overall mean length of stay. Selected two-tailed individuals are from early in the cART era and/or infected adults relies heavily on data collected in stayed longer in hospital (one-tailed p=0.005) and p-values, calculated by a bootstrap method, are shown. from developing world settings.1 the developing world and prior to the modern cART had higher mortality (2/3); no patients with •We wished to determine whether previous era; our data indicate that a large-scale updating of S. pneumoniae infection were taking cART. •Infections were associated with renal impairment findings applied to a UK teaching hospital later in this understanding may be required. (14/26 infections). the cART era. Acknowledgements •5/26 patients (20%) had haematological We should like to thank Dr Matthew Longbone and the Methods malignancy; 4 of those were on active •In a teaching hospital on the English south coast. Department of Microbiology at the Royal Sussex County chemotherapy (see Table 1). Hospital, Brighton, for assistance with data queries. •Catchment population approximately 500 000. •All had neutrophils <0.2/nL on hospital admission. JPS is funded under the UK National Institute of Health •Diagnosed HIV-positive cohort mostly attend a •The patients were younger (mean age 41 years). Research’s Academic Clinical Fellowship scheme. single clinic. 1434 local authority residents aged 15-59 receiving HIV care in 2012 (7.75 per 1000)5; Disclosures Co-morbidity Number of No relevant conflicts of interest to disclose. overall clinic HIV cohort size today is 2400. bacteraemias •All instances of positive blood cultures from 2014 Selected References studied (n=1075). Lymphoma or leukaemia 5† (4 in patients on 1. Huson MAM et al. Community-acquired bacterial •One instance defined as non-contaminant chemotherapy) bloodstream infections in HIV-infected patients: a systematic review. Clinical Infectious Diseases bacteria within a 31-day rolling window. Kidney transplant 2 2014;58(1):79-92 and references therein. •Augmented by clinical coding search over five-year ESRF on dialysis and T2DM 1 2. Kim JH et al. All-cause mortality in hospitalized HIV- period with terms “HIV AND (sepsis OR septicaemia infected patients at an acute tertiary care hospital OR bacteraemia)” (n=63). Adrenal insufficiency 3 with a comprehensive outpatient HIV care program in •Results amalgamated and bacterial IHD 1† New York City in the era of highly active antiretroviral contaminants/negative blood cultures excluded. therapy (HAART). Infection 2013;41(2):545-51. AIDS dementia 1† 3. Jambo KC et al. Small alveolar macrophages are Figure 1. Organisms identified in blood stream infections Results infected preferentially by HIV and exhibit impaired of HIV-1 infected patients. † indicates one death within Myeloma 1 phagocytic function. Mucosal Immunol. •26 blood stream infections identified from the 5- 120 days. 2014;7(5):1116-26. year period. 1Other Gram-negative rods: A. caviae, S. maltophilia and SCC 1 •25 known HIV diagnoses; 1 new HIV diagnosis M. morganii (1 case each). Table 1. Co-morbidities of patients with bacteraemias. No 4. Huson MA, Grobusch MP and van der Poll T. The 2 effect of HIV infection on the host response to •Mean age 49.1years. Other Gram-positive cocci: Enterococcus and M. luteus† (1 case patient had comorbidities in more than one line of the each). table, but some patients are counted for more than one bacterial sepsis. Lancet Infect Dis. 2015;15(1):95-108. •22/26 (85%) male (cohort is predominantly male). 3Gram-positive rods: Corynebacterium (1 case) and 1 organism not bacteraemia. ESRF=end-stage renal failure; T2DM=type 2 5. Aghaizu A et al. (Public Health England). HIV in the •Mean length of stay 15 days. fully identified. United Kingdom: 2013 Report. 4 diabetes mellitus; IHD=ischaemic heart disease; •3/26 (15%) died within 120 days of discharge. Mycobacteria: M. tuberculosis (1 case), M. avium (2 cases) and M. cheloneae (1 case). SCC=squamous cell carcinoma.