Background Human immunodeficiency virus (HIV) infected children represent a very vulnerable population for anti-retroviral therapy (ART) drug resistance. As a global target, 90% of patients receiving ART should have HIV-RNA viral suppression. A threshold of > 1000 RNA copies/ml is used to define non-suppressed viral load. If it is confirmed in the laboratory, adherence should be addressed and should be followed by the switch to second-line ART. Therefore, the aim of this study was to assess the rate of viral load suppression among children tested at the Amhara Public Health Institute (APHI), Bahir Dar. Methods Institutional based cross-sectional study design was conducted from July 01, 2017 to June 30, 2018, in children under the age of 15 years. Socio-demographic, clinical and HIV1RNA viral load data were collected from the excel database. The data were analyzed in SPSS 20.0 statistical software. Results A total of 1567 children, age ranged from one to 14 years, were tested for HIV viral load. Of which, about 54% were males. Children were treated using nevirapine-based (76.7%), efavirenz-based (21.8%) and protease inhibitor-based (1.5%) anti-retroviral drugs. Non-suppressed HIV viral load was found in 28.3% of the participants. High viral load (> 1000 cp/ml) were found in 24% of the children below the age of five years. Children on nevirapine-based treatment had about two times more non-suppressed viral load (Adjusted odds ratio [AOR]: 1.90; 95%CI: 1.41–2.56; P < 0.001) compared to those who had efavirenz-based treatment. However, adherence (P: 0.204) was not associated with non-suppressed viral load. Conclusions There was a high rate of non-suppressed HIV viral load among children tested at APHI. Specifically, the odds of having a non-suppressed viral load was higher in NVP based treatment users. Hence, comprehensive management and follow up of children on ART, and testing for resistance as well as viral load could help to reduce the problem in advance.

Introduction: Above 80% of urinary tract infections are caused by enteric bacteria, which are known for years by their drug-resistant ability. Though the prevalence of drug-resistant strains is increasing in the world, it is not well known in low-income countries. The aim of this study was to assess the prevalence of Multi-drug resistance, Extended-spectrum β-lactamases production, and associated risk factors among pregnant women in Northwest Ethiopia. Methods: A hospital-based cross-sectional study was conducted among pregnant women from March to May 2017. A total of 384 clean-catch midstream urine sample was collected from study participants. Bacterial identification and drug susceptibility testing were done following standard microbiological techniques; Extended-spectrum β-lactamase production was screened using a disc diffusion test and confirmed by a combination disc test. The data were entered and analyzed by using SPSS version 20, and a p-value of less than 0.05 was considered as statistically significant. Result: The overall prevalence of urinary tract infection was 15.9% (95% CI 12.8-20.1%). E. coli (49.2%), CoNS (27.9%), and S. aureus (18%) were the main uropathogens. The prevalence of MDR uropathogens was 60.65%. The prevalence of ESBLs production among cases caused by Enterobacteriaceae was 18.2%. The drug resistance rate of Gram-negative isolates was higher for ampicillin (90.9%), cephalothin (84.8%), and augmentin (57.6%). The drug nitrofurantoin showed the highest activity (100%) against Gram-negative isolates. Gram-positive isolates were showed low susceptibility to penicillin (89.3%) and cotrimoxazole (75%); however highest susceptibility rate for gentamicin (100%), amikacin (100%), and nitrofurantoin (98.36%) was recorded. Prior antibiotic therapy (AOR = 5.46, 95% CI 1.38-21.65) was a risk factor for the presence of multi-drug resistant bacteria. Conclusion and recommendation: The multi-drug resistance prevalence was high among uropathogen, thus treatment of urinary tract infection during pregnancy; should be based on the antibacterial susceptibility testing result. The isolation of drug-resistant strains like Extended-spectrum β-lactamases in this study calls for the need of periodic and continuous follow-up of antibiotic usage among pregnant women. Nitrofurantoin, gentamicin, amikacin, and ciprofloxacin/norfloxacin showed higher activity against bacterial uropathogen.

There is growing evidence indicating that drug-resistant bacteria notably Extended spectrum β-lactamases producing Enterobacteria are greatly implicated in immunocompromised groups namely HIV-infected patients. Little is known about the burden of ESPL-E in places where HIV infection is rampant. Therefore, the study was aimed to assess the prevalence, antimicrobial resistance pattern of ESPL-E among HIV/AIDS patients. A cross-sectional study was conducted among HIV/AIDS patients seeking Antiretroviral Treatment (ART) service at the University of Gondar Hospital from February–May, 2017. The pretested and -structured questionnaire was used to collect data on sociodemographic and clinicalrelated factors. Clean catch midstream urine samples were collected and cultured in line with standard procedures. The drug susceptibility testing was performed by Kirby Bauer disc diffusion method. Extended-spectrum β-lactamase (ESBL) detection was performed using a doubledisc synergy test and combined disc methods. Data entry and analysis were performed using SPSS version 20. Among a total of 387 HIV/AIDS patients, 42 (10.9%) Enterobacteria uropathogens were identified. Among these isolates, nine (21.4%) were ESBL producers. The highest prevalence of ESBL production was Escherichia coli (44.4%) followed by Klebsiella pneumoniae (22.2%) and Enterobacter spp. (22.2%). Higher drug resistance rates were observed among ESBL-producing isolates compared to ESBL-nonproducing isolates. Amox-clavulanic (100%), ampicillin (95%), cotrimoxazole (74%), cefotaxime (88.9%), and ceftazidime (88.9%) had high resistance rates to Extended spectrum β-lactamases producing Enterobacteria. The overall prevalence of multidrug resistance of all isolates was 92.9%, and all the ESBL isolates were multidrug resistant. Therefore, antimicrobial stewardship programs needed to be promoted for the rational use of drugs especially in the management of HIV/AIDS patients.