Different clinical presentation of community-onset bacteremia among human immunodeficiency virus-infected and human immunodeficiency virus-uninfected adults in the ED

Objectives The objective of this study is to analyze the differences in clinical presentation and outcome of community-onset bacteremia between human immunodeficiency virus (HIV)-infected adults and HIV-uninfected adults visiting the emergency department (ED).

Methods A multicenter, case-control study with a ratio of 1:4 was conducted retrospectively over an 8-year period. Demographic characteristics, severity of illness, and clinical outcomes determined from chart records were analyzed.

Results In total, 74 HIV-infected adults (case patients) and 288 HIV-uninfected adults (control patients) were examined. Significant differences in clinical presentation, severity, and the source of bacteremia as well as bacteremia-causing microorganisms between the case patients and control patients were observed by univariate analyses. Using multivariate analyses, the following variables were positively associated with case patients: male sex (odds ratio [OR], 3.42; P =.01), bacteremia due to endocarditis (OR, 7.68; P =.007), bacteremia due to Salmonella enteritidis (OR, 4.29; P =.03), and comorbidity with chronic hepatitis (OR, 5.65; P <.001). Moreover, several independent risk factors of 28-day mortality were discovered, including inappropriate empirical antibiotic therapy after the ED visit (OR, 9.01; P <.001), an initial syndrome with septic shock (OR, 5.37; P <.001); a Pittsburgh bacteremia score greater than or equal to 4 points at the ED (OR, 4.28; P =.002), severe underlying disease based on McCabe classification (rapid and ultimately fatal; OR, 3.31; P =.002), and bacteremia due to pneumonia (OR, 2.66; P =.03). Of note, HIV infection was not a significant factor affecting 28-day mortality.

Conclusions This study demonstrated that the clinical characteristics, the severity, and the character of bacteremia in HIV-infected and uninfected patients varied among community-onset bacteremic patients visiting the ED, despite the limited impact of HIV infection on short-term outcomes.