Bacterial infections in HIV-infected children admitted with severe acute malnutrition in Durban, South Africa.
Paediatr Int Child Health
; 37(1): 6-13, 2017 Feb.
Article
em En
| MEDLINE
| ID: mdl-27376401
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.1 A 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 ß-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.
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Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Infecções Bacterianas
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Infecções por HIV
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Infecções Oportunistas Relacionadas com a AIDS
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Desnutrição Aguda Grave
Tipo de estudo:
Guideline
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Observational_studies
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Risk_factors_studies
Limite:
Child
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Child, preschool
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Female
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Humans
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Infant
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Male
País como assunto:
Africa
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article