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Pseudomonas infections in children with human immunodeficiency virus infection
E Roilides1, K M Butler, R N Husson
1Infectious Diseases Section, National Cancer Institute, Bethesda, MD 20892.
Insights
Pseudomonas infections are a growing concern in children with human immunodeficiency virus (HIV). Prompt treatment is crucial for favorable outcomes in these serious, potentially life-threatening conditions.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Immunocompromised Hosts
Background:
- Human immunodeficiency virus (HIV) infection in children presents unique challenges for managing opportunistic infections.
- Pseudomonas species (spp.) are increasingly recognized as significant pathogens in pediatric populations, particularly those who are immunocompromised.
Observation:
- A study of 236 children with HIV revealed a significant incidence of Pseudomonas spp. infections, including bacteremia and nonbacteremic cases.
- Central venous catheter (CVC)-related infections were the most common type, followed by otitis externa and pneumonia.
- Pseudomonas aeruginosa was the predominant isolate, while other Pseudomonas spp. and Xanthomonas maltophilia were primarily linked to CVC-related infections.
Findings:
- The overall infection rate was 0.098 per patient-year, with a bacteremia rate of 0.030 per patient-year.
- Four patients were identified as neutropenic (absolute neutrophil count < 500/microliter).
- Appropriate and vigorous therapeutic interventions, including catheter removal in 35% of CVC-related cases, led to favorable outcomes.
Implications:
- Pseudomonas spp. infections contribute substantially to morbidity and hospitalization in children with HIV.
- Early recognition and aggressive management are critical to prevent severe outcomes and mortality associated with these infections.
- The findings underscore the importance of surveillance and targeted antimicrobial strategies in pediatric HIV care.
Abstract:
Thirteen bacteremias and 25 nonbacteremic infections caused by Pseudomonas spp. occurred in 22 of 236 children with human immunodeficiency virus infection with a rate of infection of 0.098 (bacteremia, 0.030) per patient year. Four patients were neutropenic (less than 500/microliters). Central venous catheter (CVC)-related infections were most frequent (n = 20) followed by otitis externa (n = 6) and pneumonia (n = 5). Pseudomonas aeruginosa was the most common isolate and caused both CVC-related and CVC-unrelated infections, whereas other Pseudomonas spp. and Xanthomonas maltophilia were almost exclusively associated with CVC-related infections. The children who received appropriate therapy had a favorable outcome. In 7 CVC-related infections (35%) the catheter was removed. Pseudomonas spp. are of increasing importance in human immunodeficiency virus-infected children causing significant morbidity and increased hospitalization. These infections may be life-threatening if appropriate therapy is not vigorously initiated.