Catheter-related infections and associated septicemia.

Communications to the Editor not have active Pneumocystis carinii pneumonia (PCP). All of these patients had a history of single or recurrent episodes of PCP and were receiving aerosolized pentamidine isethionate as prophylaxis against recurrence of PCP It was suspected that the pneumothoraces were caused by coughing due to the irritative effect of pentamidine therapy on the airways superimposed on abnormal decreased lung compliance secondary to interstitial fibrosis caused by previous PCP From January 1, 1988, to January 1, 1991, 1,200 known human immunodeficiency virus-positive patients were admitted to our institution. Thirty-two patients had spontaneous pneumothorax either on admission or during hospitalization. Twenty-four patients (75 percent) with spontaneous pneumothorax were not receiving PCP prophylaxis, and only three patients(lopercent)were receiving aerosolized pentamidine prophylaxis. The incidence of spontaneous pneumothorax in our AIDS group admitted to the hospital was 2.7 percent. At the Fifth International Conference on AIDS, Newsome et al’ reported that pneumothorax occurred in eight (2.5 percent) of the 327 patients with prior PCP who had been receiving aerosolized pentamidine prophylaxis for three to 13 months; the majority (75 percent) had evidence ofactive PCP When we compared the incidence of pneumothorax in patients receiving aerosolized pentamidine prophylaxis (2.5 percent) with that in our group, who for the most part received no prophylaxis, we found no statistical difference. Although we cannot exclude the possibility that inhaled pentamidine can directly cause pneumothorex, the evidence presented more likely implicates predisposing damage from prior episodes of PCP or, more likely, ongoing tissue