Community-Acquired Bacterial Pneumonia in Human Immunodeficiency Virus-Infected Patients: Validation of Severity Criteria [Cordero E, et al. Am J Respir Crit Care Med 2000;162:2063]: The authors present a prospective, observational, hospital-based study of consecutive cases of CAP in 12 hospitals in southern Spain for one year, beginning February 1, 1996. The one-year study included 3,269 HIV-infected patients; 759 (23%) were hospitalized with CAP, including 398 (12%) with nonbacterial pneumonia and 355 (11%) with bacterial pneumonia. The distribution of pathogens was: S. pneumoniae - 39%, P. aeruginosa - 18%, and H. influenzae - 14%. The overall mortality was 9.3%. Prognostic factors that appeared to be important based on mortality were: shock, CD4 cell count <100/mm³, plural effusion, cavities, and multilobar involvement.
Comment: This is another fine study of pneumonia from Spain, and it represents the largest prospective study of persons with HIV infection. Forty-five percent of the 759 cases of CAP were considered bacterial (etiologic agents in the others were not disclosed). The rate of CAP seemed very high at 23%. This may be explained, in part, by the fact that 82% of the 355 patients were injection drug users, 82% were smokers, and 84% had AIDS. The frequency of trimethoprim-sulfa prophylaxis for PCP was 44%. The authors note that there have been many studies of prognostic factors for CAP, but virtually all exclude patients with HIV infection. This report validates the criteria of the 1993 ATS guidelines, although most studies in recent years have relied on the criteria of the PORT studies since these have substantial validation that is adamantly limited to immunocompetent patients.
posted 1/4/2001

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