Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 22106-22109 283

biologists. Statistical analyses were performed by means of the StatView 4.5"'
statistical package.
Results: From January, 1, 1992 to December 31, 1996, 79 SVR had been implanted in AIDS patients. Most of them received treatment in the day care hospital
(46, 58.2%). However, 26 (32.9%) received treatment at home. The mean number
of SVR punctures was 99 ~ 101 (range: 2-394). Thirty one patient (39.2%) were
neutropenic. The mean CD4 count was 30 + 38/mm3 (range: 1-120). Thirty nine
patients (49.4%) did not have any complication, 5 (6.3%) had non-infectious complications, 29 (36.7%) had infectious complications, and 6 (7.8%) had mechanical
and infectious complications. In 21 instances (60.0%) there was only infection
of the device chamber, whereas in another 13 cases (37.1%) simultaneous septicemia was also present. Cultures were monomicrobial in 33 cases (94.3%), and
polymicrobial in two (5.7%). The most frequent isolates were: Staphylococcus
epidermidis (19), Corynebacterium sp. (4), coagulase negative staphylococci
(2), Staphylococcus aureus (2), and one each Strenothophomonas maltophilia,
Aeromonas caviae, Acinetobacter sp., Enterococcusfaecalis, Burkholderia cepacia, and an unidentified non-fermentative gramnegative bacillus. Antibiotic therapy
was antibiotic lock in 18 cases, systemic antibiotics in 6, and mixed antibiotic
therapy in 9. The incidence of complications was 0.20/100 catheter days. SVR
had to be retired in 16 patients, the main cause being infection in 10. The total
number of catheter days was 20159.
Conclusions: SVR in AIDS patients present a high rate of complications, with
an estimated incidence of 0.20 episodes/100 catheter days. Among them, infections are the most frequent with staphylococci as the most frequently isolated
microorganisms. Infection caused loss of the implantable port in 13% of the
patients. Antibiotic lock seems effective to treat SVR infection.
S22106 Central venous catheters (CVC)-related bacteraemia in
HIV+ subjects: 3 years prospective survey
Katleen de Gaetano. Malattie Infettive Universita Cattolica, Largo Gemelli 8,
00168 Rome, Italy
Objectives: To evaluate the incidence, aetiology and outcome of CVC-related
bacteraemia in HIV+ subjects.
Methods: Between Jan-1994 to Dec-1996, all HIV+ subjects admitted at our
ward, who had CVC (Certofix, Braun, Melstingen, Germany) implanted, were entered into this prospective study. CVC were implanted under sterile conditions and
perioperative prophylactic antibiotics were not used. Records were maintained on
demographic variables, data of CVC implantation, surgeon, insertion technique
(venipuncture or guidewire replacement), CVC indication, HIV risk behaviour,
stage of HIV infection, AIDS-related diseases, number of circulating CD4+ and
neutrophils cells/mmc, P. carinii and toxoplasmosis prophylaxis, antiretroviral
treatment.
Results: In the study period, 272 CVC were implanted in 151 HIV+ subjects
(179 M, 93 F, mean age 33 ~ 4 yr). Forty-five CVC (16%) were inserted in
neutropenic patients (PMN - 1,000/mmc) and 70 (26%) in patients under total
parenteral nutrition (TPN). The mean device life of CVC was 14.3 ~ 7.2 days. A
total number of 67 episodes of bacteraemia (25%) were observed. Over a total
of 3,825 days of catheter use, the infection rate was 1.7 cases of bacteraemia
per 100 catheter-days, The most common etiologic agents of bacteraemia were:
S. aureus (31%), S. epidermidis (29%), Pseudomonas spp. (20%), C. albicans,
(10%), On univariate analysis 4 variables affected the rate of CVC-related bacteraemia: neutropenia for more than 8 days (p = 0.004; RR = 2.72); administration
of TPN (p = 0.0001; RR = 3.66); duration of site use (p = 0.03; x2 for trend);
and number of circulating CD4+ cells -- 50/mmc (p = 0.0002; RR = 3.15). The
logistic regression analysis revealed that administration of TPN (p = 0.001; RR =
2.19) and neutropenia (p = 0.02; RR = 197) were independent predictive factors
for bacteraemia. Catheter replacement with a guidewire was no more likely to be
associated with bacteraemia than percutaneous catheter insertion. Forty case of
bacteraemia (60%) required CVC removal. Fifty-nine patients (88%) recovered
after appropriate antibiotic therapy. Eight patients (12%) died.
Conclusions: These date suggest that CVC related infections are not an
uncommon event in AIDS patients particularly if they are neutropenic and under
TPN.
22107 Emerging gram-negative bacterial pathogens in the
setting of HIV disease: frequency and clinical
significance
Roberto Manfredi1 2, F. Chiodo2. 1Infectious Diseases-University of Bologna Via
Massarenti, 11 U-40138 Bologna; 2 nfectious Diseases-University of Bologna,
Italy
Objective: To assess the frequency, clinical significance and outcome of Xanthomonas sp., Alcaligenes xylosoxidans, and Campylobacter jejuni bacteremia
and pneumonia, as emerging bacterial complications in patients (p) with HIV
disease.
Methods: Retrospective survey of clinical and microbiological records of
-2,000 HIV-infected p followed since 1991.

Results: Fourty-nine episodes of X. maltophilia infection (Coacteremia in 44
cases, pneumonia in 5), and 14 episodes of X. campestris bacteremia were
observed in 61 p of 2,000 (3.1%). Xanthomonas sp. infections occurred at a
mean CD4+ count of 56.1 - 22.3 cells/p/L, while a neutrophil count < 1,000//tL
was detected in 27 of 63 episodes (42.9%). The majority of cases (42 of 63:
66.7%) were nosocomial in origin, and often interested p with a prior diagnosis of
AIDS (67.2%). Most p (71.4%) underwent a prior antibiotic and/or steroid therapy,

while a central i.v. catheter was detected in only 8 cases. Xanthomonas sp.
isolates showed poor antibiotic susceptibility levels: at least 80% of strains were
resistant against ureidopenicillins, aztreonam, imipenem, first- and second-generation cephalosporins, and aminoglycosides. Clinical and microbiological cure
was obtained in 57 p of 61, while in the remaining 4 AIDS p with sepsis, a CD4+
count < 30/p1L and neutropenia, Xanthomonas sp. infection contributed to death.
Moreover, 7 cases of sepsis and/or lower respiratory tract infection caused by A.
xylosoxidans were observed in our -2,000 HIV-infected p (0.35%) (6 nosocomial
in origin, 5 associated with AIDS and a very low CD4+ cell count, and 2 with
an infected indwelling i.v. catheter). The in vitro susceptibility testing showed
an elevated resistance profile to first-generation cephalosporins, aztreonam and
aminoglycosides. Recovery was attained in 6 p after 5-13 days of antibiotic
therapy, while the remaining p (with pneumonia and pleural effusion) had a slow
resolution. Finally, 2 cases of nosocomial C. jejuni bacteremia without focal or
enteric involvement, but complicated by a rapidly fatal course, were observed in
p with AIDS, a severe immunodeficiency and other underlying diseases (CMV
infection in both p, and liver cirrhosis in the second p). Despite a timely and
seemingly appropriate antimicrobial treatment, in both p C. jejuni infection had
an unfavorable outcome, relapsing in one case and rapidly lethal in both p (as
confirmed by autopsy studies), with a septic shock-like clinical picture, previously
described only once.
Conclusion: Xanthomonas sp., A. xylosoxidans and C. jejuni are emerging
organisms in immunocompromised p, but very limited data are available to date
in the setting of AIDS. In our series, Xanthomonas and Alcaligenes sp. infection presented notable frequency and severity (not previously recognized to the
same extent), and C. jejuni caused isolated, fatal sepsis. These gram-negative
pathogens, showing a broad clinical spectrum and an unpredictable antibiotic
susceptibility, may lead to life-threatening complications in hospitalized p with
advanced HIV disease and concurrent risk factors.
22108 HIV-associated pneumonias: The efficacy of
pneumococcal vaccine (PV)
Gildon Beall1, Mario Guerrero1, S. Kruger1, A. Saitoh1, F. Sorvillo2, K.J. Cheng2,
C. French1. 1Harbor UCLA Medical Center, 1000 W. Carson St., Torrance, CA;
2 HIV Epidemiology Program, Los Angeles, CA, USA
Objectives: To assess the efficacy of PV and influenza vaccine (IV) in prevention
of pneumonia in HIV-infected persons.
Methods: All patients seen at our center since 1990 have been entered into
the Centers for Disease Control Adult Spectrum of Disease Study. Records from
95 patients with and 95 case controls without pneumonia matched by CD4 count
were reviewed for IV and PV status and prophylaxis for M. avium (MAC). Patients:
44% white, 28% African-american (A-A), 26% Hispanic, 3% Asian, 13% female,
15% intravenous drug users (IDU).
Results: In a bivariate analysis patients with pneumonia were less likely than
controls to have received pneumococcal vaccine (49 v 77%), influenza vaccine
(38 v 60%) and prophylaxis for MAC (6 v 16%). Multivariate (logistic regression
analysis) revealed:

PV
IDU
A-A

Adjusted odds ratio
0.31
3.4
2.5

Confidence intervals
0.15, 0.67
1.3, 8.6
1.2, 5.4

p
0.003
0.01
0.02

The risk reduction by MAC prophylaxis and IV were not statistically significant.
Addition of more patients may produce such a result.
Conclusions: PV was associated with a 70% decreased risk of pneumonia in
HIV/AIDS patients. Intravenous drug users and African-americans were at greater
risk of pneumonia.
22109 Community acquired bacteremia and mycobacteremia in
febrile adults admitted to Mulago hospital in Kampala,
Uganda
Moses R. Kamya1, S.N. Ssali1, F. Wabire-Mangen1, S. Kasasal, M. Joloba1,
R. Mugerwa1, J.L. Johnson2. Makerere Univ. Department of Medicine Mulago
Hospital PO Box 7051 Kampala, Uganda; 2Case Western Reserve University
Cleveland OH, USA
Background: Opportunistic infections are major causes of morbidity and mortality among HIV-infected individuals especially those with advanced immunosuppression. Few studies have prospectively examined the causes of bloodstream
infections (BSI) in febrile HIV-infected adults in developing countries.
Objective: To assess the prevalence and aetiology of community acquired BSI
among febrile adult medical admissions to Mulago Hospital, Kampala, Uganda.
Methods: 299 consecutive patients with fever (new medical admissions) were
studied between January and April 1997. Study subjects were evaluated by history and physical examination; complete blood count; HIV-1 serology; chest x-ray,
and blood cultures. Twenty ml of blood was inoculated into biphasic brain heart
infusion and BACTEC 13A media. The BACTEC 460TB system was used for the
mycobacterial cultures.
Results: The median age was 30 years, 53% were males and 76% were
HIV-1 infected. Overall, the prevalence of bacteremia or fungemia was 24%.
Bacteremia occurred more frequently among HIV-infected than HIV-non-infected
(24% vs. 15%, p = 0.04). M. tuberculosis (n = 28), Strep. pneumoniae (n = 15)
and Salmonella spp (n = 13) were the most frequent isolates. Candida albicans