Pneumococcal infections in children with HIV

HW positive (+) children with S. pneumoniae (SP) infections were identified retrospectively from patients (pts) with SP infections enrolled in the US PMPSO study from 9/93-4/97 to compere the clinical and laboratory characteristics of pts with penicillin (PCN) susceptible (S) vs. non-susceptible (NS) isolates. To date 44 episodes were examined in 33 pts; 3 pts-3, 5 pts-2 episodes. Males accounted for 55% of the cases; 60% of the patients were black. Thirty pts had perinatally acquired HIV. Sixty-one percent of the pts were CDC clinical class C, 30%-B, 9%-A; 67V. were CDC immunologic class 3, class 2 (12%), and class 1 (21%). Bacteremia (6) occurred in 93% of the cases. Of the 44 isolates 9 (21 %) were intermediate (I) and 4 (9%) were resistant (R) to PCN. Four isolates were 1 and 3 were R to cefiriaxone. Characteristics of pts with S vs. NS isolates are as follows: Characteristic S(n=21) NS(n=12) p-value Age (Median (M),r) mos 41.5 (5-211) 47.5(7.5-284) CDC Clinical Class C 11 (52%) 9 (75%) 0.20 CDC tamunologic Class 3 11 (52%) 11 (92%) 0.021 CD4 count (M,r) cells/mm³ 773 (2-2011) 278 (1-1057) 0.05 Abx course within 30 d 0 (0%) 4 (33%) 0.005 Diagnoses in the pts included B-27%, B+pneumonia (P)-21%, B+ otitis (O)-21%, B+sinusitis(S)-12%, B+P+O-6%,; 3 pts had O and 1 had B+P+S. Serotype 6 was the most conunon-46% followed by serotypes 23, 14, 19, 9, and 4. Median hospital duration in 8 pts with NS isolates was 9.5d (r 3-18d) vs. 5d (r 2-12d) in 11 pts with S isolates. The most common antibiotic (Abx) regimen used in all pts was a 2nd/3rd generation parenteral cephalosporin + course of oral Abx Infection resolved in all pts; 3 pts died-nonc of the deaths were related to their infection. Conclusion: HIV + pts with NS isolates were more immunologically impaired and likely to have received a course of Abx within 30d of their SP infection, than HIV+ pts with S isolates.