Magnitude of Multidrug-resistant Bacterial Uropathogens and Associated Factors in Urinary Tract Infection Suspected Adult HIV-Positive Patients in Southern Ethiopia

Abstract

Background: Due to the reduction of their immunity, people living with the human immunodeficiency virus (HIV) are more susceptible to acquiring urinary tract infections (UTI). Moreover, the emergence of drug-resistant bacterial uropathogens has grown widely and now constitutes a severe clinical problem among HIV-positive patients. Methods: An institution-based cross-sectional study was conducted at the ART clinic of Arba Minch General Hospital from 1st January to 30th May, 2021. A total of 251 adult HIV-positive patients clinically suspected of having UTIs were systematically recruited. Socio-demographic and other factors were collected by a pre-tested structured questionnaire. A clean-catch mid-stream urine sample was collected and inoculated onto blood agar, MacConkey agar, and cysteine lactose electrolyte deficient agar (CLED). The inoculated culture media were incubated aerobically at 37°C for 24 hrs. After overnight incubation, significant bacteriuria, 105 CFU/ml, was considered. Bacterial identification was made by standard protocols. Antimicrobial susceptibility testing was done by Kirby Bauer’s disk diffusion method. The data was analyzed using SPSS version 25. A P-value less than 0.05 was used as statistical significance. Results: The overall magnitude of multidrug-resistant (MDR) uropathogens was found to be 14.3%, with a 95% CI (10-19.1). Gram-negative bacteria (83.3%) were the predominant MDR isolates, with E. coli (41.7%) followed by K. pneumoniae (22.2%). All isolates of S. aureus and two-thirds of the isolated CoNS were MDR. A total of 30% and 16.7% of Gram-negative isolates were ESBL and carbapenemase producers, respectively, whereas 50% and 33.3% of isolated S. aureus and CoNS were methicillin-resistant, respectively. Antibiotic use in the previous 6 months [AOR = 6.7, 95% CI: (2.53-17.6)], presence of chronic underlying disease [AOR = 7.03, 95% CI: (1.72-28.73)], antibiotic use without a prescription [AOR = 9.7, 95% CI: (3.53-26.675)], CD4+ counts less than 250 cells/mm3 [AOR = 8.05, 95% CI: (2.078–31.154)], and CD4+ count in between 250-500 cells/mm3 [AOR = 2.49, 95% CI: (1.05-5.923)] were found to be statistically significant associated with MDR uropathogens. Conclusion: This study found a significant number of multidrug-resistant uropathogens, indicating that healthcare providers should be aware of this and take urgent action to minimize resistance spread, as well as consider current empirical antibiotic therapy for UTI in HIV-positive patients.

Magnitude and associated factors of bacterial urinary tract infections among paediatric patients in Arba Minch, southern Ethiopia

“…Nevertheless, only a lower extent of MDR was reported from northern part of Ethiopia [ 21 ], and Nepal [ 33 ]. The present study also revealed that a higher prevalence (76.2%) of MDR was shown by GNB, which is in line with the results of a couple of studies done in Ethiopia (Bahir Dar and Arba Minch) [ 22 , 40 ]. In contrast, a higher prevalence of MDR among Gram-positive strains was reported by a couple of previous studies done in Ethiopia [ 30 , 31 ].…”

“…aureus were MRSA. This trend was by and large similar to a recent study conducted among HIV patients in the study area, Arba Minch [ 40 ]. However, it is on the higher side in comparison to the outcome of previous studies conducted in Bahir Dar [ 22 ] and Arba Minch [ 41 ], Ethiopia where the resistance observed was only 33.3 and 42.5% respectively.…”

“…Also, it has been found that K. pneumoniae 66.7% (4/6) is the most predominant ESBL producer, followed by E. coli 55.6% (5/9). In contrast, findings of an earlier study in Arba Minch itself revealed that E. coli is the most prominent ESBL producer, followed by K. pneumoniae [ 40 ].…”

“…This is comparable to the findings of a study done in Addis Ababa (although the study participants were not similar to ours) [ 43 ] as well as in Turkey [ 44 ]. In contrast, lower prevalence of ESBL were reported in some of the previous studies conducted in Arba Minch [ 40 ], Bahir Dar [ 22 ], Nepal [ 33 ] and India [ 38 ]. Also, it has been found that K. pneumoniae 66.7% (4/6) is the most predominant ESBL producer, followed by E. coli 55.6% (5/9).…”

Correlation of CD4+ count and viral load with urinary tract infection and antimicrobial resistance pattern of bacterial uropathogens among HIV patients in Wolaita Sodo, South Ethiopia

“…The permanence of HIV patients in hospitals increases the risk of nosocomial transmission of virulent microorganisms, which can migrate into and out of the hospital environment (Panis et al, 2009 ). E.coli, K. pneumoniae, P. mirabilis, P. aeruginosa, S. aureus , and S. saprophyticus are the most common bacterial etiologies of UTI (Panis et al, 2009 ; Marami et al, 2019 ; Simeneh et al, 2022 ).…”