[P. aeruginosa bacteremias: analysis of prognostic factors. A prospective study, 1992-1998]. / Bacteriemias por P. aeruginosa: análisis de los factores pronóstico. Estudio prospectivo 1992-1998.

INTRODUCTION: P. aeruginosa causes serious infections with high mortality. OBJECTIVES: Identify the prognostic factors associated with higher mortality in P. aeruginosa bacteremias (PAB). METHODS: 211 consecutive cases of PAB were analyzed prospectively between 1992-1998. Blood cultures, isolation, and antimicrobial sensitivity were carried out according to microbiology standard methodology. The variables analyzed as prognostic factors were: sex, age, source of infection, background, main disease, initial clinical severity, foci, presence of complications, leukocyte count, type of antibiotic treatment and adaptation. Bivariate and multivariate statistical analyses were carried out by the method of logistic regression. RESULTS: Global mortality was 27.96%; factors associated with higher mortality in the bivariate study were main disease rapidly and eventually fatal, diabetes, a situation of critical initial clinical severity, lung focus, complications, neutropenia and inadequate antibiotic treatment. The logistic regression study, the critical initial clinical severity, and the presence of complications were the variables associated with worse prognosis. We did not find significant differences in the evolution among the patients who received monotherapy and those on combinations of antimicrobial drugs against pseudomonas. CONCLUSION: Higher mortality of PAB is statistically associated to the situation of critical initial clinical severity and to the presence of complications; therefore, an early diagnosis and adequate treatment to improve the morbidity and mortality are recommended.

[Mycobacterium avium-intracellulare disseminated infection in patients with AIDS]. / Infección diseminada por Mycobacterium avium-intracellulare en pacientes con SIDA.

BACKGROUND: Disseminated infection by Mycobacterium avium-intracellulare is almost exclusively produced in individuals with HIV infection. The incidence of this infection in Spain is unknown. METHODS: The clinical and microbiologic registries of 30 patients with AIDS and disseminated infection by Mycobacterium avium are reviewed. METHODS: Twenty-three percent of the patients with AIDS had, at some time in their evolution, disseminated infection by M. avium. The clinical picture included prolonged fever, digestive symptoms, weight loss and appearance of lymph node enlargement. This infection appeared in patients with severe alteration of cellular immunity (mean CD4 lymphocytes: 0.19 x 10(9)/l). Although medium term prognosis was bad the causes of death of the patients were other opportunistic diseases related with the immunodeficiency. CONCLUSIONS: Infection by Mycobacterium avium is frequent among the population of individuals with HIV infection. With the appearance of prolonged fever in a patient with HIV infection and CD4 lymphocyte count lower than 0.2 x 10(9)/1 appropriate microbiologic studies including blood cultures for mycobacteria should be initiated.