Gram-negative bacillary bacteremia in human immunodeficiency virus type 1-infected children

Chokechai Rongkavilit, Zoe M. Rodriguez, Orlando W Gomez-Marin, Gwendolyn B Scott, Cecilia Hutto, Delia Rivera-Hernandez, Charles D Mitchell

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background. HIV-infected children are particularly susceptible to serious bacterial infections including Gram-negative bacillary bacteremia (GNB). However, the information available on GNB in these children is limited. Methods. Retrospective review of hospital charts of HIV-infected children with GNB diagnosed between 1980 and 1997. The association between bacteremic episodes, degree of immunosuppression, HIV severity, medical treatment and clinical outcome was assessed. Results. Of 680 HIV-infected children, 72 (10.6%) had 95 episodes of GNB. Statistical analyses were restricted to data from the first episode. The mean age (±SD) at diagnosis of GNB was 2.5 ± 2.7 years (median, 1.6). The predominant organisms were Pseudomonas aeruginosa (26.4%), nontyphoidal Salmonella (15.3%), Escherichia coli (15.3%) and Haemophilus influenzae (12.5%). The relative frequency, per 5-year interval, of P. aeruginosa bacteremia steadily increased from 13% during 1980 through 1984 to 56% during 1995 through 1997. There were no cases of H. influenzae bacteremia after January 1, 1990. Eighty percent of GNB developed in children with AIDS and 72.2% developed in those with severe immunosuppression. Hypogammaglobulinemia and neutropenia were present in only 4.9 and 10.4% of first episodes, respectively. The overall case-fatality rate of GNB was 43.0%, and in children younger than 12 months it was 54.2%. Conclusions. A diagnosis of AIDS and/or severe immunosuppression was associated with increased risk of GNB, especially among younger children. Because of the high mortality of GNB, a broad spectrum antimicrobial therapy that effectively covers these organisms should be promptly instituted when bacteremia is suspected in HIV-infected children.

Original languageEnglish
Pages (from-to)122-128
Number of pages7
JournalPediatric Infectious Disease Journal
Volume19
Issue number2
DOIs
StatePublished - Feb 1 2000

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Bacteremia
HIV-1
HIV
Immunosuppression
Haemophilus influenzae
Pseudomonas aeruginosa
Acquired Immunodeficiency Syndrome
Gram-Negative Bacterial Infections
Agammaglobulinemia
Mortality
Neutropenia
Salmonella
Escherichia coli

Keywords

  • Bacteremia
  • Children
  • Gram-negative bacillary
  • Human immunodeficiency virus

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)

Cite this

Gram-negative bacillary bacteremia in human immunodeficiency virus type 1-infected children. / Rongkavilit, Chokechai; Rodriguez, Zoe M.; Gomez-Marin, Orlando W; Scott, Gwendolyn B; Hutto, Cecilia; Rivera-Hernandez, Delia; Mitchell, Charles D.

In: Pediatric Infectious Disease Journal, Vol. 19, No. 2, 01.02.2000, p. 122-128.

Research output: Contribution to journalArticle

Rongkavilit, Chokechai ; Rodriguez, Zoe M. ; Gomez-Marin, Orlando W ; Scott, Gwendolyn B ; Hutto, Cecilia ; Rivera-Hernandez, Delia ; Mitchell, Charles D. / Gram-negative bacillary bacteremia in human immunodeficiency virus type 1-infected children. In: Pediatric Infectious Disease Journal. 2000 ; Vol. 19, No. 2. pp. 122-128.
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AU - Hutto, Cecilia

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AB - Background. HIV-infected children are particularly susceptible to serious bacterial infections including Gram-negative bacillary bacteremia (GNB). However, the information available on GNB in these children is limited. Methods. Retrospective review of hospital charts of HIV-infected children with GNB diagnosed between 1980 and 1997. The association between bacteremic episodes, degree of immunosuppression, HIV severity, medical treatment and clinical outcome was assessed. Results. Of 680 HIV-infected children, 72 (10.6%) had 95 episodes of GNB. Statistical analyses were restricted to data from the first episode. The mean age (±SD) at diagnosis of GNB was 2.5 ± 2.7 years (median, 1.6). The predominant organisms were Pseudomonas aeruginosa (26.4%), nontyphoidal Salmonella (15.3%), Escherichia coli (15.3%) and Haemophilus influenzae (12.5%). The relative frequency, per 5-year interval, of P. aeruginosa bacteremia steadily increased from 13% during 1980 through 1984 to 56% during 1995 through 1997. There were no cases of H. influenzae bacteremia after January 1, 1990. Eighty percent of GNB developed in children with AIDS and 72.2% developed in those with severe immunosuppression. Hypogammaglobulinemia and neutropenia were present in only 4.9 and 10.4% of first episodes, respectively. The overall case-fatality rate of GNB was 43.0%, and in children younger than 12 months it was 54.2%. Conclusions. A diagnosis of AIDS and/or severe immunosuppression was associated with increased risk of GNB, especially among younger children. Because of the high mortality of GNB, a broad spectrum antimicrobial therapy that effectively covers these organisms should be promptly instituted when bacteremia is suspected in HIV-infected children.

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