Objective: Descriptive study of severe respiratory infections caused by Pseudomonas aeruginosa in patients with HIV infection.
Methods: Review of clinical records of HIV-positive patients admitted in a tertiary hospital from 1-1-1990 to 9-30-1995. The patients included in this study were those with P. aeruginosa recovered from respiratory or blood samples and respiratory symptoms.
Results: Forty patients suffered 77 episodes. The incidence in the HIV-positive admitted population during the study period was 2.6% but 3.2% in the last year. Ninety-seven percent of patients met criteria for AIDS. Twenty-eight patients (70%) had other bacterial infections. In 78% of patients no classical predisposing factor was found for this infection. Twenty-seven patients (67.5%) came regularly to the day hospital or had been previously admitted to the hospital (recent hospitalization). Twenty-five episodes (32.5%) were tracheo-bronchitis and 50 pneumonias (65%), of which 14 (28%) were cavitated and 7 (14%) bacteremic. Forty-nine percent of episodes were recurrences. Ten out of 15 tracheo-bronchitis in the first episode recurred; the new episode was more severe in 7 patients. Five patients received secondary prophylaxis after the second episode (4 with tobramycin in aerosol and 1 with colistin in aerosol). Two patients had recurrences after 86 and 62 days (mean: 74; SD: 12). Eight out of the 11 patients who did not receive prophylaxis (73%) had recurrence after a mean of 23 days (SD: 10) (p = 0.002). The mortality rate associated with P. aeruginosa was 22.5%.
Conclusions: The incidence of P. aeruginosa infections in our HIV-positive patients was 2.6% (3.2% in the last year). It is associated with severe immunosuppression and previous bacterial infection. The subacute involvement of the lower respiratory tract is most common. Over 50% of infections tend to recur more severely. The secondary prophylaxis increased the symptom-free period, although the number of patients who received it was small.