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Sepsis in children with human immunodeficiency virus infection. The Madrid HIV Pediatric Infection Collaborative
J Ruiz-Contreras1, J T Ramos, T Hernández-Sampelayo
1Department of Pediatrics, Hospital Doce de Octubre, Universidad Complutense, Madrid, Spain.
Insights
Bacterial sepsis is common in children with human immunodeficiency virus (HIV), with nontyphoidal Salmonella and Streptococcus pneumoniae being frequent causes. Complications like septic shock occurred in a significant number of cases.
Area of Science:
- Pediatric Infectious Diseases
- Immunology
- Microbiology
Background:
- Bacterial sepsis poses a significant threat to children with human immunodeficiency virus (HIV).
- Understanding the specific pathogens and patterns of sepsis in this vulnerable population is crucial for effective management.
Purpose of the Study:
- To determine the frequency and etiological patterns of bacterial sepsis in children with HIV.
- To identify common bacterial pathogens and associated infections in pediatric HIV patients experiencing sepsis.
Main Methods:
- Retrospective chart review of 233 HIV-infected children over a 10-year period.
- Analysis of sepsis episodes, causative organisms, and associated infections in tertiary hospitals.
- Data collection on patient demographics, HIV classification, and clinical outcomes.
Main Results:
- 43 sepsis episodes occurred in 31 (13%) children; 20 had acquired immunodeficiency syndrome.
- Most common pathogens: nontyphoidal Salmonella (23%), Streptococcus pneumoniae (21%), Staphylococcus epidermidis (14%).
- Associated infections included pneumonia, urinary tract infections, and catheter-related bacteremia; 6 children experienced septic shock.
Conclusions:
- Bacterial sepsis is a frequent complication in HIV-infected children, with specific bacterial profiles.
- Prompt recognition and management are essential due to high complication rates, including septic shock and mortality.
Abstract:
The aims of this retrospective study were to review the frequency and patterns of bacterial sepsis in children infected with human immunodeficiency virus. The charts of 233 human immunodeficiency virus-infected children cared for during a 10-year period in 4 tertiary hospitals in Madrid were reviewed. There were 43 episodes of sepsis in 31 (13%) children. Twenty of them had acquired immunodeficiency syndrome, 10 were class PA2 and 1 was class P1B. The most common organisms recovered were: nontyphoidal Salmonella, 10 cases (23%); Streptococcus pneumoniae, 9 cases (21%); Staphylococcus epidermidis, 6 cases (14%); Escherichia coli, 5 cases (12%); Enterococcus faecalis, 4 cases (9%); Campylobacter jejuni, 2 cases (5%). In 28 episodes of bacteremia there were other sites of associated infection: pneumonia, 6 cases; urinary tract infection (UTI), 5 cases; gastrointestinal disease, 4 cases; catheter-related bacteremia, 12 cases. Eight patients had more than 1 episode of bacteremia. The rate of complications was high: 6 children had septic shock; and 2 of them developed disseminated intravascular coagulation. There was 1 death directly related to sepsis.