Retroviral coinfections at a New Orleans HIV outpatient clinic.

The purpose of the study was to determine the seroprevalence of human T-lymphotropic virus types I and II (HTLV-I and HTLV-II) infections in an outpatient clinic population of human immunodeficiency virus (HIV)-1 infected persons as well as to identify the demographic and clinical characteristics and laboratory results associated with HTLV-I/II infections. During 1993-1995, 854 patients were tested for HTLV-I/II infection on entry into the clinic, of whom 25 were infected with HTLV-I and 35 with HTLV-II. Multivariate analysis revealed that patients with coinfections were more likely to be black, aged over 35 years, and have a history of injection drug use. HIV-1/HTLV-I coinfections were associated with higher median CD8 counts on entry (p < 0.05), and HIV-1/HTLV-II coinfections were associated with higher median percent CD4 counts (p < 0.05) compared with patients infected with HIV only. Coinfection was not associated with an increased diagnosis of AIDS. These findings indicate that HIV-1/HTLV-I/II coinfections are frequently diagnosed and are associated with unique immune phenotypes. Given the lack of information regarding the influence of dual infection on clinical status, differentiation of HTLV-I from HTLV-II infections may be important in understanding the clinical significance of retroviral coinfections.

Nosocomial central venous catheter-related infections in intensive care units.

To examine the recent microbiology of catheter-related infections (CRIs) in the intensive care unit (ICU) setting and to determine the association between selected factors and mortality among ICU patients diagnosed with a CRI, a retrospective review of all ICU patients determined to have a CRI between January 1992 and December 1994 was undertaken. A total of 108 patients with 111 episodes of CRIs were identified. The most common isolate was coagulase negative staphylococcus (37.9%), followed by Staphylococcus aureus (20.9%). Methicillin resistance was common in both CNS (93%), and S aureus (42%) isolates. Factors predictive for death in a multivariate analysis were as follows: male sex (relative risk (RR) 2.43, 95% confidence interval (CI) 1.0, 6.07), hypotension (RR 6.90, 95% CI 1.56, 12.2), American Society of Anesthesiologist physical status score greater than 3 (RR 4.36, 95% CI 1.56, 12.2), and underlying medical condition (RR 3.50, 95% CI 1.17, 10.5). This study demonstrated the increasing proportion of CRIs due to methicillin-resistant organisms in the ICU. Functional status and degree of illness were the strongest predictors for survival in this population.