Bacteremia in febrile human immunodeficiency virus-infected children presenting to ambulatory care settings.

Abstract

Risk factors for bacteremia in febrile HIV-infected children are unknown. 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. In a birth cohort of 42 HIV-infected children, all febrile outpatient encounters at < or = 36 months of age were reviewed for HIV disease severity, presence of a central venous catheter (CVC) and the usage of antibiotics and/or intravenous immunoglobulin (IVIG). Blood culture results, highest temperature and white blood cell count (WBC) were noted. There was a mean of 1.8 febrile visits (210 visits/116.5 subject years) per child year of observation. Rapid HIV-disease progressors (n=14) were 4 times more likely to have a febrile visit than 28 non-rapid HIV disease progressors (P < 0.01). Blood cultures and WBCs were obtained for 87 and 89% of the febrile visits, respectively. Eleven of the 27 positive blood cultures grew Streptococcus pneumoniae and 16 grew CVC related organisms. The only pathogen identified (n=9) in 104 febrile visits in children without a CVC was S. pneumoniae, which was often (7 of 9) associated with mild illnesses. In children without a CVC temperature > or = 39 degrees C was significantly associated with S. pneumoniae bacteremia (P < 0.05). In 79 febrile visits by subjects with a CVC, temperature > or = 39 degrees C and WBC > or = 15000 cells/mm3 were frequently observed in the 16 bacteremic compared with the 63 nonbacteremic episodes (P < or = 0.05). There was a trend toward fewer S. pneumoniae bacteremias (3 of 11) in febrile subjects who were receiving antibiotics or IVIG. HIV-infected children younger than 36 months of age have a high incidence of S. pneumoniae and CVC-related bacteremias. Temperature > or = 39 degrees C, WBC > or = 15000 cells/mm3 and the presence of a CVC should be considered in the management of febrile HIV-infected children.