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Children who have HIV, S. aureus more likely to have severe illness
McNeil JC. Pediatr Infect Dis J. 2012;doi:10.1097/INF.0b013e318239c1fe.
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Children who have comorbid infections with Staphylococcus aureus and HIV are more likely to have severe infection, according to results of a small study from Baylor College of Medicine in Houston.
J. Chase McNeil, MD, and colleagues retrospectively looked at data on 20 patients who were admitted to Texas Children’s Hospital Retrovirology Clinic for possible S. aureus infection.
Of 28 isolates, 82% were methicillin-resistant S. aureus, and 43% were clindamycin-resistant. “Case patients were more likely to have used antibiotics in the previous 6 months than controls, 69% compared with 25%,” the researchers said, with the most commonly used antibiotic being clindamycin.
About 90% of the isolates had pulsed-field gel electrophoresis patterns that indicated the USA300, or the clone most commonly associated with community-associated MRSA.
The researchers compared patients with HIV and MRSA with those who did not have both infections and said, “Case patients had more advanced HIV disease as measured by significantly lower median CD4 T-cell counts, higher viral loads and a higher CDC category of disease.”
Although the researchers noted some limitations, mainly the small study size and retrospective design, they said their findings should flag HIV medical providers to “remain vigilant for the possibility of their severely immunocompromised patients developing staphylococcal infections.”
Disclosure: The researchers report no relevant financial disclosures.
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When we think of common infections in patients with HIV, our minds typically race to the usual suspects such as Pneumocystis, TB, or CMV. But in this study from Texas Children's, McNeil and colleagues remind us that S. aureus plays a prominent role in pediatric HIV morbidity, occurring despite prophylaxis with TMP-SMX.
There are at least three points to be made. First, patients with advanced HIV disease, high viral loads and recent antibiotic use have increased risk for staphylococcal disease. Second, this work aligns nicely with the work of GHESKIO in Haiti, in which S. aureus appears to be the leading cause of bacteremia in children with HIV. Third, the relationship between CD4 count and staphylococcal disease may provide a clue into the mechanisms used by the host to control S. aureus. Hopefully this can further unlock our understanding of this formidable pathogen.
C. Buddy Creech, MD, MPH
Infectious
Diseases in Children Editorial Board member