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Sequencing of Bacterial Microflora in Peripheral Blood: our Experience with HIV-infected Patients
Published on: June 11, 2011
Bacterial disease and antimicrobial susceptibility patterns in HIV-infected, hospitalized children: a retrospective
Heather B Jaspan1, Lyen C Huang, Mark F Cotton
1University of Cape Town School of Child and Adolescent Health, Cape Town, South Africa. heather.jaspan@sbri.org
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 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.
Insights
Serious bacterial infections pose significant risks for children with HIV. Key pathogens like Klebsiella pneumoniae and methicillin-resistant Staphylococcus aureus are common, necessitating careful antibiotic selection in resource-limited settings.
Area of Science:
- Pediatric Infectious Diseases
- HIV/AIDS Research
- Microbiology and Antimicrobial Resistance
Background:
- Serious bacterial infections (SBIs) are a leading cause of illness and death in children with human immunodeficiency virus (HIV).
- The types of bacteria causing SBIs and their resistance patterns vary by geographic location and healthcare setting.
- Antibiotic prophylaxis and the rise of multi-drug resistant organisms (MDROs) in HIV-infected children require ongoing surveillance of causative agents and their antibiotic susceptibilities.
Purpose of the Study:
- To identify common bacterial pathogens responsible for serious infections in hospitalized HIV-infected children.
- To determine the antimicrobial susceptibility patterns of these pathogens.
- To differentiate between community-acquired and hospital-acquired (nosocomial) infections.
Main Methods:
- A retrospective cohort study was conducted on HIV-positive pediatric admissions at an urban public hospital in Cape Town from January 2002 to June 2006.
- Included were children aged 1 month to 9 years with confirmed HIV, SBI, and hospitalization of at least 5 days.
- Cultures from blood, urine, and cerebrospinal fluid were analyzed for organisms and their antibiotic susceptibility, comparing community- vs. hospital-acquired isolates.
Main Results:
- 141 children were included (median age 1.2 years); 39% received antiretroviral therapy.
- Pneumonia was the most frequent infection (67%), affecting all organ systems.
- Common pathogens included Streptococcus pneumoniae, Staphylococcus aureus (all methicillin-resistant), and Klebsiella pneumoniae (all nosocomial and resistant to multiple antibiotics).
Conclusions:
- Bacterial infections significantly contribute to co-morbidity in HIV-infected children, particularly in resource-limited areas.
- Healthcare providers should maintain a low threshold for initiating antibiotics in hospitalized children with suspected infections.
- Empirical antibiotic choices for serious bacterial infections in HIV-infected children should consider prevalent organisms and local antimicrobial resistance patterns, using broad-spectrum agents judiciously.
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