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Community-acquired bacteremia in human immunodeficiency virus-infected children in Harare, Zimbabwe
K J Nathoo1, S Chigonde, M Nhembe
1Department of Paediatrics, University of Zimbabwe Medical School, Harare Central Hospital, PRM.
Insights
HIV-infected children in Africa face a higher risk of bacteremia, especially younger ones. Early pathogen identification and treatment are crucial for reducing mortality in these vulnerable children.
Area of Science:
- Pediatric Infectious Diseases
- Global Health
- HIV/AIDS Research
Background:
- High prevalence of Human Immunodeficiency Virus (HIV) infection in mothers and children in Zimbabwe.
- HIV-infected children exhibit increased susceptibility to bacterial infections.
- Limited data exists on the causes and outcomes of HIV-related bacteremia in African children.
Purpose of the Study:
- To investigate the etiology and clinical outcomes of bacteremia in hospitalized children in Zimbabwe.
- To assess the association between HIV infection, bacteremia, and mortality in this population.
Main Methods:
- Analysis of blood cultures from 309 hospitalized children, including 168 diagnosed with HIV.
- Statistical assessment of the relationship between significant bacteremia, HIV status, and mortality.
Main Results:
- Common bacterial isolates included coagulase-negative staphylococci, Staphylococcus aureus, and Streptococcus pneumoniae.
- HIV-infected children had a significantly higher risk of bacteremia (OR=2.68), particularly those under 18 months (OR=2.94).
- Enterobacteriaceae infections were markedly increased in HIV-infected children (OR=15.76); mortality was higher in bacteremic children and HIV-infected infants.
Conclusions:
- Bacteremia poses a significant threat to hospitalized children in Zimbabwe, with HIV infection being a major risk factor.
- Prompt pathogen identification and timely antimicrobial therapy are essential to decrease morbidity and mortality.
- Further research is needed to understand and combat bacterial infections in HIV-affected children in resource-limited settings.
Background:
HIV infection is common in mothers and their children in Zimbabwe, and HIV-infected children are particularly susceptible to bacterial infections. There is little information on the etiology and outcome of HIV-related bacteremia in African children.
Methods:
Blood cultures from 309 hospitalized children in Zimbabwe, of whom 168 were diagnosed as having HIV, were examined for pathogens. The association among significant bacteremia, HIV infection and mortality was assessed in these children.
Results:
The most common isolates were coagulase-negative staphylococci (31 children, 25 clinically significant), Staphylococcus aureus (22 children) and Streptococcus pneumoniae (20 children). Nontyphoidal Salmonella (10 children), Escherichia coli (4 children) and Klebsiella sp. (4 children) were the most frequent Gram-negative bacteria. Two children had Rhodococcus equi pneumonia. HIV-infected children showed increased risk of bacteremia (odds ratio (OR) = 2.68), especially if younger than 18 months of age (OR = 2.94), and high risk of enterobacteremia (OR = 15.76). There was no significant association of bacteremia with nutritional status. Mortality was 17% overall but was higher in HIV-infected children up to 6 months of age (OR = 2.81) and in bacteremic children of any age (OR = 2.03).
Conclusions:
Prompt recognition of pathogens and early administration of appropriate antimicrobials is important in reducing the morbidity and mortality associated with bacteremia in HIV-infected children in Africa.