title: Bacterial infections in HIV-infected children admitted with severe acute malnutrition in Durban, South Africa.
abstract: BACKGROUND
  Bacterial infections in HIV-infected children admitted with severe acute malnutrition (SAM) contribute to higher mortality and poorer outcomes. This study describes the spectrum of bacterial infections in antiretroviral treatment (ART)-naïve, HIV-infected children admitted with SAM.
  
  
  METHODS
  Between July 2012 and February 2015, 82 children were prospectively enrolled in the King Edward VIII Hospital, Durban. Specimens obtained on and during admission for microbiological evaluation, if clinically indicated, included blood, urine (obtained by catheterisation or suprapubic aspiration), induced sputum and cerebrospinal fluid. All positive bacterial cultures between admission and 30 days after enrollment were documented and characterised into samples taken either within 2 days of admission (infections on admission) or within 2-30 days of admission (hospital-acquired infections, HAIs).
  
  
  RESULTS
  On admission, 67% of patients had abnormal white blood cell counts (WBCC) (>12 or <4 × 109/L) and 70% had elevated CRP; 65% were classified as severely immunosuppressed according to the WHO immunological classification.1A pathogen was isolated on the admission blood culture in four patients (6%) and in 27% of urine specimens. HAIs were predominately Gram-negative (39/43), and 39.5% were extended-spectrum β-lactamase-positive. Mortality was not significantly associated with isolation of a bacterial pathogen.
  
  
  CONCLUSIONS
  Routine pre-hospital administration of antibiotics as per the Integrated Management of Childhood Illness (IMCI) guidelines may be responsible for the low rates of positive admission blood cultures. HAIs with drug-resistant Gram-negative organisms are an area of concern and strategies to improve the prevention of HAIs in this vulnerable population are urgently needed.
authors.affiliation: a King Edward VIII Hospital , Durban.|b Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine , University of KwaZulu-Natal , Durban , South Africa.
authors.forename: Moherndran
authors.initials: M
authors.lastname: Archary
authors.affiliation: b Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine , University of KwaZulu-Natal , Durban , South Africa.|c Department of Infectious Diseases , Mater Misericordiae University Hospital , Dublin , Ireland.
authors.forename: Hugh
authors.initials: H
authors.lastname: Adler
authors.affiliation: d Department of Pediatrics, College of Physicians and Surgeons , Columbia University , New York , USA.
authors.forename: Philip
authors.initials: P
authors.lastname: La Russa
authors.affiliation: e Department of Medical Microbiology , KZN Academic Complex, National Health Laboratory Service , South Africa.
authors.forename: Prasha
authors.initials: P
authors.lastname: Mahabeer
authors.affiliation: a King Edward VIII Hospital , Durban.|b Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine , University of KwaZulu-Natal , Durban , South Africa.
authors.forename: Raziya A
authors.initials: RA
authors.lastname: Bobat
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000382:microbiology; D001424:Bacterial Infections / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006779:Hospitals, Public; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D000067011:Severe Acute Malnutrition / Q000150:complications*; D013019:South Africa / Q000453:epidemiology; D016019:Survival Analysis; D062606:Tertiary Care Centers
keywords: Bacterial infections; Paediatric HIV; Severe acute malnutrition