Increased disease burden and antibiotic resistance of bacteria causing severe community-acquired lower respiratory tract infections in human immunodeficiency virus type 1-infected children.
To improve the management of lower respiratory tract infections (LRTI) in human immunodeficiency virus type 1 (HIV-1)-infected children, we assessed the burden of disease, clinical outcome and antibiotic susceptibility of bacteria causing severe community-acquired LRTI in children. A prospective, descriptive study was performed in the pediatric wards at a secondary and tertiary care hospital in South Africa. Urban black children aged 2-60 months admitted with severe acute LRTI from March 1997 through February 1998 were enrolled. HIV-1 infection was present in 45.1% of 1215 cases of severe LRTI. Bacteremia occurred in 14.9% of HIV-1-infected and in 6.5% of HIV-1-uninfected children (P<.00001). The estimated relative incidence of bacteremic severe LRTI in children aged from 2 to 24 months were greater in HIV-1-infected than in -uninfected children for Streptococcus pneumoniae (risk ratio [RR], 42.9; 95% confidence interval [CI], 20.7-90.2), Haemophilus influenzae type b (RR, 21.4; 95% CI, 9.4-48.4), Staphylococcus aureus (RR, 97.9; 95% CI, 11.4-838.2) and Escherichia coli (RR, 49.0; 95% CI, 15.4-156). Isolation of Mycobacterium tuberculosis was also more common in HIV-1-infected than in -uninfected children (RR, 22.5; 95% CI, 13.4-37.6). In HIV-1-infected children, 60% of S. aureus and 85.7% of E. coli isolates were resistant to methicillin and trimethoprim-sulfamethoxazole, respectively. The case-fatality rates among HIV-1-infected children was 13.1%, and among HIV-1-uninfected children, 2.1% (adjusted odds ratio [AOR]; 6.52, 95% CI, 3.53-12.05; P<.00001). The changing spectrum of bacteria and antibiotic susceptibility patterns in HIV-1-infected children requires a reevaluation of the empirical treatment of community-acquired severe LRTI in children from developing countries with a high prevalence of childhood HIV-1 infection.
South African Institute for Medical Research, Medical Research Council Pneumococcal Diseases Research Unit, and Paediatric Infectious Disease Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa.
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Madhi
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Petersen
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Madhi
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Khoosal
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Klugman
D017088:AIDS-Related Opportunistic Infections / Q000382:microbiology*; D016470:Bacteremia / Q000150:complications / Q000382:microbiology / Q000503:physiopathology; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000150:complications / Q000382:microbiology* / Q000503:physiopathology; D004352:Drug Resistance, Microbial; D015497:HIV-1; D006192:Haemophilus Infections / Q000150:complications / Q000382:microbiology / Q000503:physiopathology; D006193:Haemophilus influenzae / Q000187:drug effects; D006801:Humans; D007223:Infant; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D018410:Pneumonia, Bacterial / Q000150:complications / Q000382:microbiology* / Q000503:physiopathology; D011018:Pneumonia, Pneumococcal / Q000150:complications / Q000382:microbiology / Q000503:physiopathology; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000150:complications / Q000382:microbiology / Q000503:physiopathology; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000382:microbiology / Q000503:physiopathology