[Community-acquired and nosocomial septicemias in patients with human immunodeficiency virus infection].
OBJECTIVES: Study the characteristics of community and nosocomial-acquired bacteremia in HIV-infected patients in order to improve curative, and if possible, preventive therapy. METHODS: We analyzed retrospectively 47 cases of community-acquired and 31 cases of nosocomial bacteremia identified in 63 of 436 patients hospitalized between January 1992 and December 1993 with HIV infection (53 men, 10 women, mean age 34.3 years, stage A: 1, stage B: 20, stage C: 42). The portal was identified for 68 episodes (40 in the community acquired and 28 in the nosocomial groups). The main portal was pulmonary infection (42.5% vs 17.8%; p = 0.03) and digestive tract infection due to Streptococcus pneumoniae (70%) and Salmonella spp (60%). Nosocomial bacteremia following intravenous infusions included Staphylococcus epidermidis (oxacillin-resistant in 57%) and Staphylococcus (oxacillin-sensitive) infections. Bacteremia was the immediate cause of death in 18% of the deaths occurring in the 436 patients hospitalized during the study period. CONCLUSION: These findings confirm the gravity of community-acquired and nosocomial bacteremia in advanced stage HIV-infected patients. Antibiotics should be adapted on the basis of probability of the infectious agent obtained from epidemiologic data and the effectiveness of prophylaxis measures validated.