Bacteraemia in HIV-1 infected children on antiretroviral therapy in Uganda and Zimbabwe in the ARROW clinical trial
Bacteraemia is a common cause of morbidity and mortality in HIV-infected children; the commonly isolated pathogens including: S. pneumoniae, S. aureus and Enterobacteriaceae. Most isolates are susceptible to cephalosporins, but high rates of resistance to cotrimoxazole and penicillin have been observed. Data on patterns of the bacteraemia pathogens and their antimicrobial sensitivity patterns still limited. ARROW is a randomized trial investigating first-line treatment and monitoring strategies in 1207 previously untreated HIV-1-infected children initiating ART. Most children had received haemophilus influenzae type B vaccination as part of the EPI schedule. None had received pneumococcal vaccination. Children developing febrile illnesses in follow-up were investigated for infections including blood culture and sensitivity done according to standard microbiological techniques. The results showed that of 848 blood cultures obtained from 461 children, 123 (14.5%) from 105 children were positive. Among children with positive isolates: 54/105 (51%) were girls and the median age was 4 (range: 0.5 - 15) years. In conclusion, high rates of proven bacteraemia were observed during the first year on ART in African HIV-infected children. Streptococcus pneumoniae was most commonly isolated, suggesting a need for effective prophylactic antibiotics and/or pneumococcal vaccination. High rates of resistance to commonly used antibiotics suggest that newer agents like ceftriaxone should be the drugs of choice when treating HIV-infected children with possible bacteraemia.
Musiime, V.; Cook, A.; Bakeera-Kitaka, S; Vhembo, T.; Lutaakome, J.; Keishanyu, R.; Prendergast, A.; Lubwama, S.; Robertson, V.; Hughes, P.; Nathoo, K.; Munderi, P.; Musoke, P.; Gibb, D.M. Bacteraemia in HIV-1 infected children on antiretroviral therapy in Uganda and Zimbabwe in the ARROW clinical trial. Presented at 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention, 17 – 20 July 2011, Rome, Italy. (2011) 1 pp.