title: Antibiotic resistance among pathogens causing disease in Jamaican children with HIV/AIDS.
abstract: OBJECTIVE
  There are limited data regarding the antimicrobial resistance patterns of pathogens in children with HIV/AIDS from developing countries. We aimed to determine the prevalence and antibiotic susceptibility patterns of bacterial pathogens causing urinary tract infections (UTIs) and sepsis in a cohort of 219 HIV-infected Jamaican children.
  
  
  METHODS
  This cross-sectional study examined clinical and microbiological data for children enrolled in the Kingston Paediatric/Perinatal HIV/AIDS programme from September 1, 2002 to May 31, 2007. Cases were defined as physician-diagnosed, laboratory confirmed UTIs and sepsis based on Centers for Disease Control and Prevention (CDC) criteria. Only isolates from urine, blood and sterile sites were considered.
  
  
  RESULTS
  Forty-four patients (20.1%) accounted for 74 episodes of UTIs and sepsis. Mean number of infections was 1.7 +/- 1.3 per patient. There were 31 males (70.5%) and mean age at time of infection was 5.6 +/- 4.7 years. Bacterial infections comprised cystitis (n = 52, 70.3%), bacterial pneumonia (n = 15, 20.3%), meningitis (n = 4, 5.4%), septicaemia (n = .2, 2.7%) and bone infection (n = 1, 1.4%). Among 52 UTIs, 39 were caused by a single organism. The most common UTI isolates included Escherichia coli (n = 21, 53.8%) and Enterobacter spp (n = 5, 12.8%). Among 22 cases of sepsis, isolates included Streptococcus pneumoniae (n = 8, 36.4%) and coagulase negative Staphylococcus (n = 6, 27.3%). All E coli isolates at two of three clinical sites were resistant to cotrimoxazole. There were 79.7% (n = 51) of infectious episodes with a cotrimoxazole-resistant organism occurring among those on cotrimoxazole prophylaxis.
  
  
  CONCLUSIONS
  Escherichia coli was the most frequent bacterial isolate. Cotrimoxazole is a poor choice for empiric treatment of sepsis and UTIs in this clinical setting.
authors.affiliation: Yale School of Public Health, The University of the West Indies, Kingston 7, Jamaica.
authors.forename: P R
authors.initials: PR
authors.lastname: Byam
authors.forename: R B
authors.initials: RB
authors.lastname: Pierre
authors.forename: C D C
authors.initials: CD
authors.lastname: Christie
authors.forename: W A
authors.initials: WA
authors.lastname: Andiman
authors.forename: M
authors.initials: M
authors.lastname: Pettigrew
mesh_terms: D015153:Blotting, Western; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004352:Drug Resistance, Microbial; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006679:HIV Seropositivity / Q000276:immunology*; D006801:Humans; D016867:Immunocompromised Host; D007563:Jamaica; D008297:Male; D008826:Microbial Sensitivity Tests; D016133:Polymerase Chain Reaction; D018805:Sepsis / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology