Gram-negative bacillary bacteremia in human immunodeficiency virus type 1-infected children.
BACKGROUND
HIV-infected children are particularly susceptible to serious bacterial infections including Gram-negative bacillary bacteremia (GNB). However, the information available on GNB in these children is limited.


METHODS
Retrospective review of hospital charts of HIV-infected children with GNB diagnosed between 1980 and 1997. The association between bacteremic episodes, degree of immunosuppression, HIV severity, medical treatment and clinical outcome was assessed.


RESULTS
Of 680 HIV-infected children, 72 (10.6%) had 95 episodes of GNB. Statistical analyses were restricted to data from the first episode. The mean age (+/-SD) at diagnosis of GNB was 2.5 +/- 2.7 years (median, 1.6). The predominant organisms were Pseudomonas aeruginosa (26.4%), nontyphoidal Salmonella (15.3%), Escherichia coli (15.3%) and Haemophilus influenzae (12.5%). The relative frequency, per 5-year interval, of P. aeruginosa bacteremia steadily increased from 13% during 1980 through 1984 to 56% during 1995 through 1997. There were no cases of H. influenzae bacteremia after January 1, 1990. Eighty percent of GNB developed in children with AIDS and 72.2% developed in those with severe immunosuppression. Hypogamma-globulinemia and neutropenia were present in only 4.9 and 10.4% of first episodes, respectively. The overall case-fatality rate of GNB was 43.0%, and in children younger than 12 months it was 54.2%.


CONCLUSIONS
A diagnosis of AIDS and/or severe immunosuppression was associated with increased risk of GNB, especially among younger children. Because of the high mortality of GNB, a broad spectrum antimicrobial therapy that effectively covers these organisms should be promptly instituted when bacteremia is suspected in HIV-infected children.
Rongkavilit
C
C
Department of Pediatrics, University of Miami School of Medicine, FL, USA.
Rodriguez
Z M
ZM
Gómez-Marín
O
O
Scott
G B
GB
Hutto
C
C
Rivera-Hernandez
D M
DM
Mitchell
C D
CD
D016470:Bacteremia / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D016946:Gram-Negative Aerobic Rods and Cocci / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D015658:HIV Infections / Q000150:complications* / Q000628:therapy; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D012189:Retrospective Studies; D012720:Severity of Illness Index