Bacterial Disease and Antimicrobial Susceptibility Patterns in HIV-Infected, Hospitalized Children: A Retrospective Cohort Study
Open Access
- 24 September 2008
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 3 (9), e3260
- https://doi.org/10.1371/journal.pone.0003260
Abstract
Serious bacterial infections are a major source of morbidity and mortality in HIV-infected children. The spectrum of disease is wide, and responsible organisms vary according to setting. The use of antibiotic prophylaxis and the emergence of multi-drug resistant bacteria necessitate examination of responsible organisms and their antibiotic susceptibility. A retrospective cohort study of all HIV-positive pediatric admissions at an urban public sector hospital in Cape Town between January 2002 and June 2006 was conducted. Children between the ages of one month and nine years with laboratory confirmed HIV status, serious bacterial infection, and a hospital length of stay of 5 days or more, were eligible for inclusion. Organisms isolated from blood, urine, and cerebral spinal fluid cultures and their antimicrobial susceptibility were examined, and compared according to timing of isolation to distinguish nosocomial versus community-acquired. One hundred and forty-one children were identified (median age 1.2 years), 39% of whom were on antiretrovirals started before or during this hospitalization. Bacterial infections involved all organ systems, however pneumonia was most common (67%). S. pneumoniae and S. aureus were the most common gram positive and K. pneumoniae was the most common gram negative organism. K pneumoniae isolates were resistant to many first and second line antibiotics, and were all considered nosocomial. All S. aureus isolates were methicillin resistant, some of which were community-acquired. Bacterial infections are an important source of co-morbidity in HIV-infected children in resource-limited settings. Clinicians should have a low threshold to initiate antibiotics in children requiring hospitalization. Broad-spectrum antibiotics should be used judiciously. Clinicians caring for HIV-infected children should be cognizant of the most common organisms affecting such children, and of their local antimicrobial susceptibilities, when treating empirically for serious bacterial infections.This publication has 26 references indexed in Scilit:
- High incidence of antimicrobial resistant organisms including extended spectrum beta-lactamase producing Enterobacteriaceae and methicillin-resistant Staphylococcus aureusin nasopharyngeal and blood isolates of HIV-infected children from Cape Town, South AfricaBMC Infectious Diseases, 2008
- Trends in Opportunistic Infections in the Pre–and Post–Highly Active Antiretroviral Therapy Eras Among HIV-Infected Children in the Perinatal AIDS Collaborative Transmission Study, 1986–2004PEDIATRICS, 2007
- Effect of age, polymicrobial disease, and maternal HIV status on treatment response and cause of severe pneumonia in South African children: a prospective descriptive studyThe Lancet, 2007
- Hospitalization and Mortality among HIV-Infected Children after Receiving Highly Active Antiretroviral TherapyClinical Infectious Diseases, 2007
- Effect of cotrimoxazole on causes of death, hospital admissions and antibiotic use in HIV-infected childrenAIDS, 2007
- Immunogenicity, Safety, and Predictors of Response After a Pneumococcal Conjugate and Pneumococcal Polysaccharide Vaccine Series in Human Immunodeficiency Virus-Infected Children Receiving Highly Active Antiretroviral TherapyThe Pediatric Infectious Disease Journal, 2006
- Impact of conjugate Haemophilus influenzae type b (Hib) vaccine introduction in South AfricaBulletin of the World Health Organization, 2006
- Immunogenicity and effectiveness of Haemophilus influenzae type b conjugate vaccine in HIV infected and uninfected African childrenVaccine, 2005
- Decrease in Hospitalization and Mortality Rates among Children with Perinatally Acquired HIV Type 1 Infection Receiving Highly Active Antiretroviral TherapyClinical Infectious Diseases, 2004
- CDC definitions for nosocomial infections, 1988American Journal of Infection Control, 1988