COMMUNITY-ACQUIRED BACTEREMIA IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED CHILDREN IN HARARE, ZIMBABWE

Background. HIV infection is common in mothers and their children in Z imbabwe, and HIV-infected children are particularly susceptible to bac terial infections, There is little information on the etiology and out come of HIV-related bacteremia in African children. Methods. Blood cul tures from 309 hospitalized children in Zimbabwe, of whom 168 were dia gnosed as having HIV, were examined for pathogens. The association amo ng significant bacteremia, HIV infection and mortality was assessed in these children. Results. The most common isolates were coagulase-nega tive staphylococci (31 children, 25 clinically significant), Staphyloc occus aureus (22 children) and Streptococcus pneumoniae (20 children), Nontyphoidal Salmonella (10 children), Escherichia coli (4 children) and Klebsiella sp, (4 children) were the most frequent Gram-negative b acteria, Two children had Rhodococcus equi pneumonia. HIV-infected chi ldren showed increased risk of bacteremia (odds ratio (OR) = 2.68), es pecially if younger than 18 months of age (OR = 2.94), and high risk o f enterobacteremia (OR = 15.76), There was no significant association of bacteremia with nutritional status, Mortality was 17% overall but w as higher in HIV-infected children up to 6 months of age (OR = 2.81) a nd in bacteremic children of any age (OR = 2.03). Conclusions. Prompt recognition of pathogens and early administration of appropriate antim icrobials is important in reducing the morbidity and mortality associa ted with bacteremia in HIV-infected children in Africa.