ABSTRACT
BACKGROUND: There is little information on nasopharyngeal (NP) flora or bacteremia in HIV-infected children. Our aim was to describe the organisms and antimicrobial resistance patterns in children enrolled in a prospective study comparing daily and three times weekly trimethoprim-sulfamethoxazole (TMP-SMX) and isoniazid (INH) or placebo prophylaxis. METHODS: NP swabs were taken at baseline from HIV-infected children enrolled in the study. Standard microbiological techniques were used. Children were grouped according to previous or current exposure to TMP-SMX and whether enrolled to the study during a period of hospitalization. Blood culture results were also recorded within 12 months of baseline. RESULTS: Two hundred and three children, median age 1.8 (Interquartile [IQ]: 0.7-4) years had NP swabs submitted for culture. One hundred and eighty-four (90.7%) had either stage B or C HIV disease. One hundred and forty-one (69.8%) were receiving TMP-SMX and 19 (9.4%) were on antiretroviral therapy. The majority, 168 (82%) had a history of hospitalization and 91 (44.8%) were enrolled during a period of hospitalization. Thirty-two subjects (16.2%) died within 12 months of study entry. One hundred and eighty-one potential pathogens were found in 167 children. The most commonly isolated organisms were Streptococcus pneumoniae (48: 22.2%), Gram-negative respiratory organisms (Haemophilus influenzae and Moraxella catarrhalis) (47: 21.8%), Staphylococcus aureus (44: 20.4%), Enterobacteriaceae 32 (14.8%) and Pseudomonas 5 (2.3%). Resistance to TMP-SMX occurred in > 80% of pathogens except for M. catarrhalis (2: 18.2% of tested organisms). TMP-SMX resistance tended to be higher in those receiving it at baseline (p = 0.065). Carriage of Methicillin resistant S. aureus (MRSA) was significantly associated with being on TMP-SMX at baseline (p = 0.002). Minimal inhibitory concentrations (MIC) to penicillin were determined for 18 S. pneumoniae isolates: 7 (38.9%) were fully sensitive (MIC Subject(s)
Bacteremia/microbiology
, Drug Resistance, Bacterial
, Enterobacteriaceae Infections/microbiology
, HIV Infections/complications
, Nasopharynx/microbiology
, Staphylococcal Infections/microbiology
, Anti-Infective Agents/administration & dosage
, Bacteremia/epidemiology
, Carrier State/epidemiology
, Carrier State/microbiology
, Child
, Child, Preschool
, Enterobacteriaceae/drug effects
, Enterobacteriaceae/enzymology
, Enterobacteriaceae/isolation & purification
, Enterobacteriaceae Infections/epidemiology
, Female
, Humans
, Incidence
, Infant
, Isoniazid/administration & dosage
, Logistic Models
, Male
, Methicillin Resistance
, Prospective Studies
, Risk Factors
, South Africa/epidemiology
, Staphylococcal Infections/epidemiology
, Staphylococcus aureus/drug effects
, Staphylococcus aureus/isolation & purification
, Trimethoprim, Sulfamethoxazole Drug Combination/administration & dosage
, beta-Lactam Resistance
, beta-Lactamases/biosynthesis