BACTEREMIA IN FEBRILE HUMAN IMMUNODEFICIENCY VIRUS-INFECTED CHILDREN PRESENTING TO AMBULATORY CARE SETTINGS

Background. Risk factors for bacteremia in febrile HIV-infected childr en are unknown. Objective. To describe the frequency of bacteremia in febrile HIV-infected infants and young children in ambulatory settings and its association with clinical and laboratory factors. Methods. In a birth cohort of 42 HIV-infected children, all febrile outpatient en counters at less than or equal to 36 months of age were reviewed for H IV disease severity, presence of a central venous catheter (CVC) and t he usage of antibiotics and/or intravenous immunoglobulin (IVIG). Bloo d culture results, highest temperature and white blood cell count (WBC ) were noted. Results. There was a mean of 1.8 febrile visits (210 vis its/116.5 subject years) per child year of observation. Rapid HIV-dise ase progressors (n = 14) were 4 times more likely to have a febrile vi sit than 28 non-rapid HIV disease progressors (P < 0.01). Blood cultur es and WBCs were obtained for 87 and 89% of the febrile visits, respec tively. Eleven of the 27 positive blood cultures grew Streptococcus pn eumoniae and 16 grew CVC related organisms. The only pathogen identifi ed (n = 9) in 104 febrile visits in children without a CVC was S. pneu moniae, which was often (7 of 9) associated with mild illnesses. In ch ildren without a CVC temperature greater than or equal to 39 degrees C was significantly associated with S. pneumoniae bacteremia (P < 0.05) . In 79 febrile visits by subjects with a CVC, temperature greater tha n or equal to 39 degrees C and WBC greater than or equal to 15 000 cel ls/mm(3) were frequently observed in the 16 bacteremic compared with t he 63 nonbacteremic episodes (P less than or equal to 0.05). There was a trend toward fewer S. pneumoniae bacteremias (3 of 11) in febrile s ubjects who were receiving antibiotics or IVIG. Conclusion. HIV-infect ed children younger than 36 months of age have a high incidence of S. pneumoniae and CVC-related bacteremias. Temperature greater than or eq ual to 39 degrees C, WBC greater than or equal to 15 000 cells/mm(3) a nd the presence of a CVC should be considered in the management of feb rile HIV-infected children.