Gram-negative bacillary bacteremia in human immunodeficiency virus type 1-infected children

Chokechai Rongkavilit, Zoe M. Rodriguez, Orlando Gómez-Marín, Gwendolyn B. Scott, Cecilia Hutto, Delia M. Rivera-Hernandez, Charles D. Mitchell

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26 Scopus citations


Background. HIV-infected children are particularly susceptible to serious bacterial infections including Gram-negative bacillary bacteremia (GNB). However, the information available on GNB in these children is limited. Methods. Retrospective review of hospital charts of HIV-infected children with GNB diagnosed between 1980 and 1997. The association between bacteremic episodes, degree of immunosuppression, HIV severity, medical treatment and clinical outcome was assessed. Results. Of 680 HIV-infected children, 72 (10.6%) had 95 episodes of GNB. Statistical analyses were restricted to data from the first episode. The mean age (±SD) at diagnosis of GNB was 2.5 ± 2.7 years (median, 1.6). The predominant organisms were Pseudomonas aeruginosa (26.4%), nontyphoidal Salmonella (15.3%), Escherichia coli (15.3%) and Haemophilus influenzae (12.5%). The relative frequency, per 5-year interval, of P. aeruginosa bacteremia steadily increased from 13% during 1980 through 1984 to 56% during 1995 through 1997. There were no cases of H. influenzae bacteremia after January 1, 1990. Eighty percent of GNB developed in children with AIDS and 72.2% developed in those with severe immunosuppression. Hypogammaglobulinemia and neutropenia were present in only 4.9 and 10.4% of first episodes, respectively. The overall case-fatality rate of GNB was 43.0%, and in children younger than 12 months it was 54.2%. Conclusions. A diagnosis of AIDS and/or severe immunosuppression was associated with increased risk of GNB, especially among younger children. Because of the high mortality of GNB, a broad spectrum antimicrobial therapy that effectively covers these organisms should be promptly instituted when bacteremia is suspected in HIV-infected children.

Original languageEnglish
Pages (from-to)122-128
Number of pages7
JournalPediatric Infectious Disease Journal
Issue number2
StatePublished - Feb 2000
Externally publishedYes


  • Bacteremia
  • Children
  • Gram-negative bacillary
  • Human immunodeficiency virus


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