1217. Staphylococcus aureus Infections in Children and Adolescents with HIV
Session: Poster Abstract Session: Pediatric HIV
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Staphylococcus aureus is a common pathogen in both immunocompetent and immunocompromised hosts.  Data in HIV infected adults have shown higher rates of S. aureus colonization and infection in this population.  The influence of HIV viral load and CD4+ T cell counts on S. aureus disease has varied in adult studies; there is no data in HIV-positive children.  We hypothesize that the progression of HIV disease is a risk factor for S. aureus infection in children.     

Methods: Patients with HIV and a culture proven S. aureus infection were included.   Antibiotic susceptibility and pulsed-field gel electrophoresis were carried out on all isolates.  Two age and method of HIV transmission-matched controls without a documented S. aureus infection were selected for each case and medical records were reviewed.

Results: Twenty-eight episodes of S. aureus infection were identified from 20 patients during the study period; 4/20 (20%) patients had multiple infections.  23/28 (82.1%) isolates were MRSA and 12/28 (43%) were clindamycin resistant.  One isolate was resistant to trimethoprim-sulfamethoxazole (TMP-SMX).  Twenty-one isolates were available for molecular testing; 19/21 had PFGE patterns consistent with USA300.  The demographics of cases and controls were no different; 93.3% of patients in both groups were perinatally infected.  A similar proportion of cases and controls were receiving antiretrovirals and TMP-SMX prophylaxis.  Case patients had a higher median log10 viral load than controls (3.9 vs 2.6, p = 0.04).  The median CD4 T cell count between cases and controls were significantly different (446 vs 675.5/mm3, p = 0.04).  Among children < 13 years-old, more case patients had CDC category B or C disease compared to control patients (88.9% vs 35.7%, p-value 0.01).

Conclusion: S. aureus is a significant pathogen among HIV infected children followed at TCH.  The rate of clindamycin-resistance among S. aureus in this population is higher than would be expected based on local prevalence for children with community-onset healthcare-associated infections (18%).  TMP-SMX resistance was uncommon in this population.   S. aureus infections were more common among HIV infected patients with more advanced disease as measured by CD4 T cell counts, HIV viral load and CDC staging.   

Subject Category: P. Pediatric and perinatal infections

Jonathon McNeil, MD1, Kristina Hulten, PhD2, Sheldon L. Kaplan, MD, FIDSA2, Heidi Schwarzwald, MD3 and Edward Mason, PhD4, (1)Department of Pediatrics, Baylor College of Medicine, Houston, TX, (2)Baylor College of Medicine and Texas Children's Hospital, Houston, TX, (3)Pediatrics, Section of Retrovirology, Baylor College of Medicine, Houston, TX, (4)Baylor College of Medicine, Houston, TX


J. McNeil, None

K. Hulten, None

S. L. Kaplan, Pfizer: Investigator, Research support

H. Schwarzwald, None

E. Mason, None

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