Mortality predictive factors of people living with human immunodeficiency virus and bloodstream infection.

• Between 2007 and 2016, bloodstream infections (BSI) occurred in 6.8/100 people living with HIV (PLWHIV) admitted to the infectious diseases ward. • PLWHIV were newly diagnosed in 25% of BSI admissions, most commonly late presenters. • Corticoid use, intravenous drug use, and APACHE II score were predictors of 30-day mortality. • The influence of corticotherapy in nosocomial BSI and the short-term prognosis is suggested. • Chronic diseases, lymphoma, and a CD4 cell count <200/µl had an impact on 3-year mortality. Portugal has one of the highest mortality rates for people living with HIV (PLWHIV) in Europe. After antiretroviral therapy introduction, HIV-associated mortality declined, included the one associated with bloodstream infection (BSI). However it is still high, and European data are scarce. Therefore, characterizing BSI and defining prognostic factors may improve our approach. This was a 10-year retrospective study of predictive factors for 30-day and 3-year mortality in PLWHIV with BSI in a tertiary infectious diseases ward. Of 2134 PLWHIV admissions, 145 (6.8%) had a BSI, mostly respiratory and catheter-related bacteremia and globally community-acquired. Nosocomial infections occurred in 42 (36%) cases, mostly caused by Enterococcus spp, Staphylococcus aureus , and Candida spp. PLWHIV with a BSI had higher 30-day mortality (27%) compared to those without a BSI (14%). APACHE II score, corticotherapy, and current intravenous drug use (IDU) had a prognostic impact on 30-day mortality. Three-year survival was 54% in PLWHIV with a BSI; a CD4 <200 cells, vascular or chronic pulmonary disease, and lymphoma were prognostic factors. Patients with a BSI were more likely to present advanced HIV disease, have more comorbidities, a longer length of stay, and higher 30-day mortality. IDU and severity of infection determined the short-term prognosis. Three-year mortality was primarily influenced by lower CD4 cell counts, hematological tumor, and cardiopulmonary comorbidities. Systemic corticotherapy may influence nosocomial BSI and short-term prognosis. [ABSTRACT FROM AUTHOR]