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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C. Buddy
Creech
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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