The Barbados AIDS audit: a profile of first respiratory admissions

ABSTRACT

Lower respiratory tract infections (LRTI) are the commonest cause of HIV-related hospital admissions to the Queen Elizabeth Hospital in Barbados. The medical records and available chest X-rays of 225 patients with LRT1 on their first admission during the period 1989-1995 were reviewed. The mortality among the patients was 26 percent and did not vary over the period under study. The radiologist's report on the CXR film was present in the records of 122 patients and eighty-six (70 percent) were reported as showing bilateral interstitial infiltrates. Twenty-one out of 28 (75 percent) deaths occurred in patients with bilateral interstitial infiltrates treated with the recommended dose of co-trimoxazole for Pneumocystis carinii pneumonia (PCP). Review of CXR films for nine patients with proven PCP confirmed that all had a "classical PCP" on CXR (i.e., bilateral mid-zone / diffuse fine reticulonadular or "ground glass" appearances). However, five of 11 patients with proven bacterial LRT1 (5 coliforms, 3 S.aureus, and 3 Pseudomonas sp.) also had "classical PCP" on CXR. We conclude that the high mortality may relate in part to the treatment of bacterial LRT1 with high dose co-trimoxazole. Empirical treatment should begin with gentamicin and ampicillin, with a switch to high-dose co-trimoxazole if patients fail to improve (AU)