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.
PIP: Researchers compared data on 168 HIV-positive pediatric patients with data on 141 HIV-negative pediatric patients to examine the etiology and outcome of HIV-related bacterial infections in a pediatric population admitted to Harare Hospital in Zimbabwe during June 1993 to December 1994. The age of the children ranged from less than 1 month to 96 months. 72% were less than 12 months old. 54% of all pediatric patients tested were HIV-infected. HIV-infected children were more likely to have a bacterial infection than HIV-negative children (40% vs. 20%; odds ratio [OR] = 2.68; p 0.001). The difference in the bacterial infection rate was only significant for children aged less than 18 months (41% vs. 19%; OR = 2.94; p 0.001), however. 14% of the children suffered from severe malnutrition. Nutritional status was not significantly associated with bacterial infection. In both HIV-positive and HIV-negative children, Staphylococcus aureus was the most frequent bacterial pathogen (29% for HIV-positive and 18% for HIV-negative children). Many Gram-positive and Gram-negative isolates were resistant to the combination therapy of trimethoprim-sulfamethoxazole. Only 1 child, who was HIV-positive, had more than one bacterial infection (both Streptococcus pneumoniae and Actinomyces israelii). HIV-positive children were more likely to have an enterobacterial infection than HIV-negative children (10% vs. 0.7%; p 0.001). Mortality was significantly higher among HIV-infected children aged less than 6 months old than their HIV-negative counterparts (28% vs. 12%; OR = 2.81; p 0.05). Even though it was also higher among HIV-positive children aged more than 6 months (17% vs. 7%), the difference was not significant. Regardless of HIV status, children with bacteremia were more likely to die than those without bacteremia (24% vs. 14%; OR = 2.03; p 0.05). These findings stress the importance of early and effective antibiotic therapy. This therapy will reduce the morbidity and mortality associated with bacteriemia in HIV-infected children in Africa.