Bacterial disease and antimicrobial susceptibility patterns in HIV-Infected, hospitalized children: A retrospective cohort study
Date
2008-09-24
Authors
Jaspan, Heather B.
Huang, Lyen C.
Cotton, Mark F.
Whitelaw, Andrew
Myer, Landon
Journal Title
Journal ISSN
Volume Title
Publisher
PLOS
Abstract
Background: 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.
Methodology/Principal Findings: 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.
Conclusions/Significance: Bacterial infections are an important source of co-morbidity in HIV-infected children in resourcelimited
settings. Clinicians should have a low threshold to initiate antibiotics in children requiring hospitalization. Broadspectrum
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.
Description
The orginal version is available at www.plosone.org
Keywords
HIV-infected children -- Treatment, Antibiotic prophylaxis, Multi-drug resistant bacteria in HIV-infected children, Bacterial infections -- Disgnosis, HIV-infected children -- Diseases -- Diagnosis, Pneumonia in children -- Diagnosis, HIV-infected children -- Diseases -- Treatment
Citation
Jaspan HB, Huang LC, Cotton MF, Whitelaw A, Myer L (2008) Bacterial Disease and Antimicrobial Susceptibility Patterns in HIV-Infected, Hospitalized Children: A Retrospective Cohort Study. PLoS ONE 3(9): e3260.