[Clinical and virological correlation between the cerebrospinal fluid and blood of HIV-infected children]. / Correlación clinica y virológica entre el liquido cefalo-raquideo y la sangre de niños infectados por el HIV-1.

BACKGROUND: Although the neurological manifestations of HIV infection occur at any age, children with perinatal AIDS are affected earlier and with greater impact. There are no published data about a potential association between HIV encephalopathy and viral load in THE CSF OF the pediatric population. DESIGN: Twenty-three children, aged 7 months to 10 years, were studied as part of a multicenter international study that evaluated double versus triple antiretroviral therapy. Samples of CSF and plasma were collected for HIV RNA measurements on day 0 and on follow-up weeks 8, 16, and 48. Neurological assessments, psychological evaluations, and CT scans were done on admission and at study end. Viral isolates were processed for genotypic resistance. RESULTS: No correlation between viral load in CSF and plasma was detected at study onset. Eighty percent of children had >2 log HIV RNA in CSF at day 0 but only 30% at week 16. Eight subjects responded favorably to therapy and their CSF had undetectable viral load during follow-up determinations. On day 0, 72% of children had identical patterns of genotypic resistance in CSF and plasma samples. At week 48, however, only 11% of these subjects had identical patterns. On day 0, 83% of children had abnormal neurological findings but these alterations declined to 35% at week 48 (p = 0.004). Most children with neurological abnormalities had detectable CSF viral loads (65% vs 17%, p = 0.04). CONCLUSIONS: The data generated in this study suggest that CSF and plasma behave as two different body compartments in terms of HIV dynamics and resistance mutants. Presence of neurological abnormalities correlate with detection of HIV in CSF and these alterations improve as therapy decreases CSF viral load. These results underscore the importance of using ARV drugs with good CNS penetration for optimal management of HIV-infected young children.

Impact of an antibiotic restriction policy on hospital expenditures and bacterial susceptibilities: a lesson from a pediatric institution in a developing country.

BACKGROUND: In an era of growing concern about bacterial resistance and hospital costs, limiting the use of broad spectrum antibiotics is important. OBJECTIVES: To evaluate the effects of an antibiotic restriction policy on expenditures, antimicrobial resistance rates and clinical outcomes of hospitalized children. DESIGN: Starting in January, 1997, a prior consultation with an infectious disease specialist for using restricted antibiotics was required in all hospital areas. A retrospective assessment of study objectives obtained 2 years before (1995, 1996) and 2 years after (1997, 1998) initiation of the restriction policy was performed. SETTING: The present study was conducted in a 500-bed university hospital serving children nationwide of a developing country, Panama. RESULTS: Total expenditures for antimicrobial agents decreased by 50%, from $699,543 (US dollars) during 1995 and 1996 to $347,261 during 1997 and 1998. Susceptibility rates of many nosocomial isolates (especially staphylococci and Gram-negative enteric bacilli) usually improved for restricted antibiotics with >35% reduction in utilization (notably for gentamicin, third generation cephalosporins, piperacillin and vancomycin). Major improvements in bacterial susceptibilities were observed in the nursery, a place harboring microorganisms exhibiting the higher initial resistance rates of the hospital. No differences in days of hospital stay and mortality rates of all patients and of children with nosocomial infections were detected during the study period. CONCLUSIONS: Requirement for prior approval of selected antimicrobial drugs in a pediatric institution decreases hospital expenditures and improves susceptibilities to antibiotics without compromising patient outcomes or length of hospital stays.