Jahit Sacarlal (Mozambique)
Eduardo Mondlane University Department of Microbiology, Faculty of MedicineAuthor Of 1 Presentation
COMMUNITY-ACQUIRED BACTEREMIA AMONG HIV-INFECTED CHILDREN HOSPITALIZED WITH FEVER IN MOZAMBIQUE
Abstract
Backgrounds:
Bacteremia is a major cause of morbidity and mortality worldwide with a high disease burden in developing countries. Children with HIV frequently present with bacteremia that differs in severity and frequently leads to poor outcomes. Access to a microbiology laboratory is limited in many LMIC. In Mozambique, blood culture capacity is only available at select hospitals or research centers with little impact on patient care. National antimicrobial resistance monitoring is limited.
Methods
We conducted an observational study of HIV-infected children, aged 0-59 months, hospitalized with fever between April 2016 and February 2019. A single bacterial culture was collected at admission. Descriptive statistics were used to summarize microorganisms detected and antibiotic susceptibility testing.
Results:
A total of 730 HIV-infected children were enrolled. Blood culture positivity was 12% (n=87) (95% CI: 9.9%-14.4%). Five organisms predominated: Staphylococcus aureus (37%), Klebsiella spp (11%), Salmonella spp (11%), Escherichia coli (9%) and Micrococcus (7%). Nearly 70% of Staphylococcus aureus were methicillin-resistant and roughly 50% of Klebsiella had ESBL production. An additional 146 blood cultures grew Coagulase-negative staphylococcus (CoNS). Originally felt to be contamination, however in subsequent analysis, CoNS showed a statistically significant association with clinical respiratory symptoms compared to other organisms (aOR 1.66, 95% CI: 1.15, 2.41, p=0.03).
Conclusions/Learning Points:
Community-acquired bacteremia was common in HIV-infected children hospitalized in Mozambique with a fever. High rates of MRSA and ESBL producing organisms have implications for empiric antibiotics utilized in Mozambique. National laboratory capacity providing consistent and high-quality data on antimicrobial prevalence and their antibiotic susceptibility patterns is badly needed to guide policy for drug formulary expansion and antibiotic prescription guidelines. Focused studies should be done to better determine the pathogenic potential of CoNS in this context.