Bacteremia, Causative Agents and Antimicrobial Susceptibility Among HIV-1–infected Children on Antiretroviral Therapy in Uganda and Zimbabwe

Musiime, Victor; Cook, Adrian; Bakeera-Kitaka, Sabrina; Vhembo, Tichaona; Lutakome, Joseph; Keishanyu, R.; Prendergast, Andrew J.; Lubwama, S.; Robertson, Val J.; Hughes, Peter J.; Nathoo, Kusum; Munderi, Paula; Klein, Nigel; Musoke, Philippa; Gibb, Diana

doi:10.1097/inf.0b013e31828c3991

Cited by 28 publications

(29 citation statements)

References 35 publications

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“…Amikacin and meropenem were the most potent drugs against Gram-negative isolates with more than 80.0% of the isolates being sensitive, similar to findings from a study in the USA [7]. Conversely, more than 60.0% of the isolates were resistant to third generation cephalosporins, in contrast with the USA and an earlier study in Zimbabwe where 80-100% were sensitive [7,20]. This difference could be due to the wide availability and uncontrolled use of ceftriaxone as first line treatment, as was found in this study.…”

Section: Discussionsupporting

confidence: 79%

“…Cefoxitin and piperacillin-tazobactum were effective against 66.7 and 71.4% of all the Gramnegative isolates. However, more than 90.0% of the isolates were resistant to trimethoprim-sulfamethoxazole and ampicillin, a finding similar to most studies worldwide [16,20,24]. The resistance to trimethoprimsulfamethoxazole has been attributed to overuse of the drug as prophylaxis against Pneumocystis jirovecii pneumonia in HIV endemic regions such as Zimbabwe.…”

Section: Discussionsupporting

confidence: 67%

“…Conversely, there was high rate of methicillin resistance which impliedly apply to cloxacillin, one of the EDLIZ prescribed empiric antimicrobial agent. The low activity observed in penicillin was previously reported in Ghana, India and Zimbabwe [20,24,25]. Enterococcus and Streptococcus species in our study were highly sensitive to fosfomycin, vancomycin and linezolid with the latter being the most effective (isolates were 100.0% sensitive) antibiotic.…”

Section: Discussionsupporting

confidence: 44%

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Sepsis in cancer patients residing in Zimbabwe: spectrum of bacterial and fungal aetiologies and their antimicrobial susceptibility patterns

et al. 2020

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Background: Cancer and sepsis comorbidity is a major public health problem in most parts of the world including Zimbabwe. The microbial aetiologies of sepsis and their antibiograms vary with time and locations. Knowledge on local microbial aetiologies of sepsis and their susceptibility patterns is critical in guiding empirical antimicrobial treatment choices. Methods: This was a descriptive cross-sectional study which determined the microbial aetiologies of sepsis from blood cultures of paediatric and adult cancer patients obtained between July 2016 and June 2017. The TDR-X120 blood culture system and TDR 300B auto identification machine were used for incubation of blood culture bottles and identification plus antimicrobial susceptibility testing, respectively. Results: A total of 142 participants were enrolled; 50 (35.2%) had positive blood cultures, with 56.0% Gram positive, 42.0% Gram-negative bacteria and 2.0% yeast isolated. Common species isolated included coagulase negative Staphylococcus spp. (CoNS) (22.0%), E. coli (16.0%), K. pneumoniae (14.0%), E. faecalis (14.0%) and S. aureus (8.0%). Gram-negative isolates exhibited high resistance to gentamicin (61.9%) and ceftriaxone (71.4%) which are the empiric antimicrobial agents used in our setting. Amikacin and meropenem showed 85.7 and 95.2% activity respectively against all Gram-negative isolates, whilst vancomycin and linezolid were effective against 96.2 and 100.0% of all Gram-positive isolates respectively. We isolated 10 (66.7%) extended spectrum β-lactamase (ESBL) amongst the E. coli and K. pneumoniae isolates. Ten (66.7%) of the Staphylococcus spp. were methicillin resistant. Conclusions: CoNS, E. coli, K. pneumoniae, E. faecalis and S. aureus were the major microbial drivers of sepsis amongst cancer patients in Zimbabwe. Most isolates were found to be resistant to commonly used empirical antibiotics, with isolates exhibiting high levels of ESBL and methicillin resistance carriage. A nationwide survey on microbial aetiologies of sepsis and their susceptibility patterns would assist in the guidance of effective sepsis empiric antimicrobial treatment among patients with cancer.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 67%

Section: Discussionsupporting

confidence: 44%

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Sepsis in cancer patients residing in Zimbabwe: spectrum of bacterial and fungal aetiologies and their antimicrobial susceptibility patterns

et al. 2020

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“…This is similar to the report by Madhi et al 12 with high rate of bacteraemia in HIV infected children of comparable age group. The prevalence from our study is also similar to that in the Anti Retroviral Research of Watoto (ARROW) study (14.5%) 13 and also the 15.5% found in a study at the Kwa-Zulu Natal hospital in South Africa.…”

Section: Discussionsupporting

confidence: 74%

“…13,14 We found only one case (5.3%) of CoNS infection in this study and that was detected in a subject with advanced immunosuppression. This may be because they are mainly opportunistic bacteria that are expected to be more frequent in the immunosuppressed and those with prosthetic devices and indwelling catheters.…”

mentioning

confidence: 77%

Prevalence and pattern of bacteraemia among HIV-infected under -five children in a tertiary hospital in Kano, Nigeria

Adisa¹,

Hassan-Hanga²,

Oyelami³

2017

Nig. J. Paed.

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The hard part we often forget: providing care to children and adolescents with advanced HIV disease

et al. 2023

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Introduction Many children and adolescents living with HIV still present with severe immunosuppression with morbidity and mortality remaining high in those starting antiretroviral therapy (ART) when hospitalized. Discussion The major causes of morbidity and mortality in children living with HIV are pneumonia, tuberculosis, bloodstream infections, diarrhoeal disease and severe acute malnutrition. In contrast to adults, cryptococcal meningitis is rare in children under 5 years of age but increases in adolescence. In 2021, the World Health Organizations (WHO) consolidated guidelines for managing HIV disease and rapid ART included recommendations for children and adolescents. In addition, a WHO technical brief released in 2020 highlighted the various interventions that are specifically related to children and adolescents with advanced HIV disease (AHD). We discuss the common clinical presentations of children and adolescents with AHD with a focus on diagnosis, prevention and treatment, highlight some of the challenges in the implementation of the existing package of care, and emphasize the importance of additional research to address the needs of children and adolescents with AHD. Conclusions There are limited data informing these recommendations and an urgent need for further research on how to implement optimal strategies to ensure tailored approaches to prevent and treat AHD in children and adolescents. Holistic care that goes beyond a simple choice of ART regimen should be provided to all children and adolescents with AHD.

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Bacteremia, Causative Agents and Antimicrobial Susceptibility Among HIV-1–infected Children on Antiretroviral Therapy in Uganda and Zimbabwe

Abstract: Rates of proven bacteremia were >20-fold higher immediately after starting ART compared with 12 months later in African HIV-infected children. S. pneumoniae was most commonly isolated, suggesting need for pneumococcal vaccination and effective prophylactic antibiotics.

Cited by 28 publications

References 35 publications

Sepsis in cancer patients residing in Zimbabwe: spectrum of bacterial and fungal aetiologies and their antimicrobial susceptibility patterns

Sepsis in cancer patients residing in Zimbabwe: spectrum of bacterial and fungal aetiologies and their antimicrobial susceptibility patterns

Prevalence and pattern of bacteraemia among HIV-infected under -five children in a tertiary hospital in Kano, Nigeria

The hard part we often forget: providing care to children and adolescents with advanced HIV disease

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