title: Bacterial disease and antimicrobial susceptibility patterns in HIV-infected, hospitalized children: a retrospective cohort study.
abstract: BACKGROUND
  Serious bacterial infections are a major source of morbidity and mortality in HIV-infected children. The spectrum of disease is wide, and responsible organisms vary according to setting. The use of antibiotic prophylaxis and the emergence of multi-drug resistant bacteria necessitate examination of responsible organisms and their antibiotic susceptibility.
  
  
  RESULTS
  A retrospective cohort study of all HIV-positive pediatric admissions at an urban public sector hospital in Cape Town between January 2002 and June 2006 was conducted. Children between the ages of one month and nine years with laboratory confirmed HIV status, serious bacterial infection, and a hospital length of stay of 5 days or more, were eligible for inclusion. Organisms isolated from blood, urine, and cerebral spinal fluid cultures and their antimicrobial susceptibility were examined, and compared according to timing of isolation to distinguish nosocomial versus community-acquired. One hundred and forty-one children were identified (median age 1.2 years), 39% of whom were on antiretrovirals started before or during this hospitalization. Bacterial infections involved all organ systems, however pneumonia was most common (67%). S. pneumoniae and S. aureus were the most common gram positive and K. pneumoniae was the most common gram negative organism. K pneumoniae isolates were resistant to many first and second line antibiotics, and were all considered nosocomial. All S. aureus isolates were methicillin resistant, some of which were community-acquired.
  
  
  CONCLUSIONS
  Bacterial infections are an important source of co-morbidity in HIV-infected children in resource-limited settings. Clinicians should have a low threshold to initiate antibiotics in children requiring hospitalization. Broad-spectrum antibiotics should be used judiciously. Clinicians caring for HIV-infected children should be cognizant of the most common organisms affecting such children, and of their local antimicrobial susceptibilities, when treating empirically for serious bacterial infections.
authors.affiliation: University of Cape Town School of Child and Adolescent Health, Cape Town, South Africa. heather.jaspan@sbri.org
authors.forename: Heather B
authors.initials: HB
authors.lastname: Jaspan
authors.forename: Lyen C
authors.initials: LC
authors.lastname: Huang
authors.forename: Mark F
authors.initials: MF
authors.lastname: Cotton
authors.forename: Andrew
authors.initials: A
authors.lastname: Whitelaw
authors.forename: Landon
authors.initials: L
authors.lastname: Myer
mesh_terms: D019380:Anti-HIV Agents / Q000494:pharmacology; D000890:Anti-Infective Agents / Q000494:pharmacology; D001424:Bacterial Infections / Q000150:complications* / Q000453:epidemiology* / Q000821:virology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003428:Cross Infection; D024881:Drug Resistance, Bacterial; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology* / Q000382:microbiology; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies
chemical_list: D019380:Anti-HIV Agents; D000890:Anti-Infective Agents