Treatment of postoperative infectious complications in patients with human immunodeficiency virus infection

doi:10.5847/wjem.j.issn.1920-8642.2014.02.004

Abstract

Abstract:

BACKGROUND: Antibiotics are widely given for surgical patients to prevent infection. Because of the lack of study on the rational use of antibiotics in patients with human immunodeficiency virus (HIV) -infected during surgical procedures, we analyzed the risk factors affecting postoperative infectious complications in HIV-infected patients and explore the rational use of perioperative antibiotics.
METHODS: This retrospective study consisted of 308 HIV-infected patients, 272 males and 36 females, who had undergone operation at the Shanghai Public Health Clinical Center from November 2008 to April 2012. The patients were divided into postoperative infection and non-infection groups. Their age and clinical variables were compared. The correlation between surgical incision, surgical site infection (SSI) and postoperative sepsis was analyzed. Prophylactic antibiotics were used for patients with type I and II incisions for less than 2 days. Patients with type III incisions were given antibiotics until the infection was controlled. Antiretroviral therapy (ART) was prescribed preoperatively for patients whose preoperative CD4 count was <350 cells/µL. For those patients whose preoperative CD4 count was <200 cells/µL, sulfamethoxazole and fluconazole were given preoperatively as prophylactic agents controlling Pneumocystis carinii pneumonia and fungal infection.
RESULTS: A total of 196 patients developed postoperative infectious complications, and 7 patients died. Preoperative CD4 counts, ratio of CD4/CD8 cells, hemoglobin level, and postoperative CD4 counts, hemoglobin and albumin levels were risk factors of perioperative infection in HIV-infected patients. Patients with a preoperative CD4 count <200 cell/µL, anemia, a postoperative CD4 count <200 cell/µL or albumin levels <35 g/L were correlated with a higher rate of perioperative infection. There was a significant correlation between SSI and the type of surgical incision. The rate of SSI in patients with type I surgical incision was 2% and in those with type II surgical incision was 38%. All the patients who received type III surgical incision developed SSI, and they were more likely to develop postoperative sepsis.
CONCLUSIONS: HIV-infected patients are more likely to develop postoperative infectious complications. The rational use of antibiotics in HIV-infected patients could help to reduce the rate of postoperative infectious complications in these patients.

Key words: Human immunodeficiency virus, Acquired immunodeficiency syndrome, Perioperative period, Surgical site infection, Antibiotics

Bao-chi Liu, Lei Zhang, Jin-song Su, Andy Tsun, Bin Li. Treatment of postoperative infectious complications in patients with human immunodeficiency virus infection[J]. World Journal of Emergency Medicine, 2014, 5(2): 103-106.

Figures/Tables 5

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References 12

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Variables	Group A	Group B	P
Age	47.1±13.6	40.2±12.1	0.000^*
Preoperative
CD4	362.9±283.6	211.2±161.7	0.000^*
CD8	781.2±448.9	722.1±457.3	0.335
CD4/CD8	0.49±0.29	0.34±0.29	0.000^*
WBC (×10⁹/L)	5.47±2.37	5.86±2.91	0.239
Hemoglobin (g/L)	129.3±21.7	121.5±25.9	0.009^*
Platelet (10⁹/L)	187.4±85.7	208±103.6	0.081
Albumin (mg/L)	45.5±11.2	43.5±11.8	0.197
Postoperative
CD4	311.8±136.6	199.7±161.4	0.000^*
CD8	719.6±399.9	678.6±389.9	0.591
CD4/CD8	0.51±0.29	0.87±4.98	0.655
WBC (×10⁹/L)	6.77±2.96	6.38±3.61	0.438
Hemoglobin (g/L)	121.1±20.3	112.2±25.1	0.011^*
Platelet (10⁹/L)	207.7±104	192.9±112.5	0.355
Albumin (mg/L)	44.5±11.0	40.2±10.9	0.012^*

Variables	Group A	Group B	P
Preoperative CD4 count			0.000^*
<200 cells/μL	25	108
≥200 cells/μL	86	89
Preoperative anemia			0.038^*
Yes	32	80
No	79	117
Postoperative CD4 count			0.000^*
<200 cells/μL	17	125
≥200 cells/μL	94	72
Postoperative anemia			0.056
Yes	49	120
No	62	77
Postoperative albumin level			0.002^*
<35 g/L	14	67
≥35 g/L	97	130

Variables	SSIs	Non-SSIs	P
Clean	2	94	0.000^*
Contaminated	120	73
Dirty	19	0

Variables	Sepsis	Non-sepsis	P
SSIs	69	72	0.002^*
Non-SSIs	52	115

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