Community-acquired bacteremia among HIV-infected and HIV-exposed uninfected children hospitalized with fever in Mozambique.

ABSTRACT Background Bacteremia is a major cause of morbidity and mortality worldwide. Children infected with HIV present with patterns of bacteremia that are generally associated with poor prognosis. In Mozambique, data on bacteremia are sparce, with most studies describing the epidemiology of pediatric bacteremia limited to patients near the capital city of Maputo, in the south. Methods We conducted an observational study of HIV-infected and HIV-exposed uninfected children, aged 0-59 months, that were hospitalized with fever between April 1, 2016 and February 28, 2019. A single blood specimen for bacterial culture was collected at admission. Descriptive statistics were used to summarize microorganisms detected and antibiotic susceptibility testing. Results A total of 808 HIV-infected (90%) and HIV-exposed uninfected (10%) children aged 0-59 months were enrolled in our study. The blood culture positivity rate was 12% (95% CI: 9.9%-14.4%). Five organisms accounted for most cases, with Staphylococcus Aureus being most common (37%), followed by Klebsiella spp (11%), Salmonella spp (11%), Escherichia Coli (9%) and Micrococcus (7%). Antibiotic resistance was common. Nearly 70% of Staphylococcus Aureus isolates were methicillin-resistant and roughly 50% of Klebsiella isolates had ESBL production. Conclusion Community-acquired bacteremia was common in HIV-infected and HIV-exposed uninfected children hospitalized in Mozambique with a febrile illness. A high rate of MRSA and ESBL producing organisms has implications for the empiric antibiotic choices utilized in Mozambique. Longitudinal data on the prevalence and antimicrobial resistance patterns of important pathogens are badly needed to guide national policy for drug formulary expansion and antibiotic prescription guidelines.