Atuhaire Patience, Kyohere Mary, Tusubira Valerie, Davies Hannah G, Musoke Philippa, Sekikubo Musa, Wamawobe Amusa, Peacock Joseph, Le Doare Kirsty
Makerere University-Johns Hopkins University (MUJHU) Research Collaboration, Kampala, Uganda.
Institute for Infection and Immunity, St. George's, University of London, London, UK.
Open Forum Infect Dis. 2025 Mar 10;11(Suppl 3):S187-S192. doi: 10.1093/ofid/ofae642. eCollection 2024 Dec.
Low- and middle-income countries lack data on culture-confirmed sepsis in HIV-exposed infants, despite the reported heightened risk of infectious morbidity. This study describes culture-confirmed sepsis and antibiotic resistance patterns among HIV-exposed children in a large etiological cohort study in Kampala, Uganda.
This was a prospective birth cohort study based at 2 Ugandan sites, as part of the Progressing Group B Streptococcal Vaccines (PROGRESS) study. Any infant with risk factors, signs, or symptoms of infection presenting before 3 months of age had a blood culture and nasopharyngeal swab taken to determine the etiology of neonatal and young infant sepsis.
Among 4492 blood cultures, 460 were obtained from HIV-exposed infants. Nine infants (1.9%) had positive blood cultures. The most frequently isolated organisms were , group B , and , and these organisms demonstrated resistance to the common antibiotics (aminoglycosides, penicillins, and cephalosporins) used for management of suspected sepsis. A higher proportion of the exposed babies died vs HIV-unexposed (15.8 vs 11.2; = .005). Nasopharyngeal swabs were collected from 114 infants, with 7.9% positive for at least one virus or bacterium.
Future work is needed to investigate why mortality among HIV-exposed infants persists despite maternal antiretroviral treatment. Antimicrobial resistance is an increasing concern in this setting.
尽管有报道称艾滋病毒暴露婴儿发生感染性疾病的风险有所增加，但低收入和中等收入国家缺乏经培养确诊的脓毒症数据。本研究描述了在乌干达坎帕拉进行的一项大型病因队列研究中，艾滋病毒暴露儿童经培养确诊的脓毒症及抗生素耐药模式。
这是一项基于乌干达两个地点的前瞻性出生队列研究，是B族链球菌疫苗进展（PROGRESS）研究的一部分。任何在3个月龄前出现感染危险因素、体征或症状的婴儿均进行血培养和鼻咽拭子检查，以确定新生儿和幼儿脓毒症的病因。
在4492次血培养中，460次来自艾滋病毒暴露婴儿。9名婴儿（1.9%）血培养呈阳性。最常分离出的病原体是[具体病原体1]、B族[具体病原体2]和[具体病原体3]，这些病原体对用于治疗疑似脓毒症的常用抗生素（氨基糖苷类、青霉素类和头孢菌素类）表现出耐药性。与未暴露于艾滋病毒的婴儿相比，暴露婴儿的死亡比例更高（15.8%对11.2%；P = 0.005）。从114名婴儿中采集了鼻咽拭子，7.9%的样本至少对一种病毒或细菌呈阳性。
未来需要开展工作，以调查为何尽管有母体抗逆转录病毒治疗，但艾滋病毒暴露婴儿的死亡率仍然居高不下。在这种情况下，抗菌药物耐药性日益令人担忧。
