Pharyngeal colonization and drug resistance profiles of Morraxella catarrrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae among HIV infected children attending ART Clinic of Felegehiwot Referral Hospital, Ethiopia

Abstract

BackgroundAsymptomatic pharyngeal colonization by potential bacteria is the primary reservoir for bacterial species within a population and is considered a prerequisite for development of major childhood diseases such as sinusitis, otitis media, pneumonia, bacteremia, and meningitis. However, there is dearth of data on the colonization and drug resistance pattern of the main bacterial pathogens in the pharynx of HIV infected children in Ethiopia. Therefore, this study determined the pharyngeal colonization and drug resistance profile of bacterial pathogens in HIV infected children attending ART clinic of Felegehiwot Referral Hospital (FHRH), Amhara Region, Ethiopia.MethodsA hospital based cross-sectional study was conducted from May 2016 to June 2017 at the ART clinic of FHRH. A total of 300 HIV infected children were enrolled in the study. Data on socio-demographic characteristics of the study participants were collected with face-to-face interview and patient—card review using structured questionnaire. Bacterial species were identified using standard bacteriological techniques. Drug susceptibility testing was performed using disk diffusion technique. Chi-square test was done to determine associations among variables.ResultsThe median age of the participants was 11 years. Overall, 153 (51%) of children were colonized by respiratory bacteria in their pharynx. Colonization rate was higher in children from mothers who had attained college and above levels of education than others (P = 0.04). It was also higher in children without the sign of malnutrition than others (P = 0.004). The colonization rate of S.aureus, M.catarrhalis, S.pneumoniae and H.influenzae were 88 (29%), 37 (12.3%), 31 (10.3%) and 6 (2%), respectively. S.aureus—M.catarrhalis concurrent colonization was found in 14 (4.7%) of children. Age (P = 0.03), schooling (P = 0.045) and history of running nose (P = 0.043) were significantly associated with S.aureus colonization. Living in urban setting (P = 0.042) and children from mothers with college and above levels of education (P = 0.002) were significantly associated with M.catarrhalis colonization. Majority of the isolates were resistant to penicillin (68.5%) and cotrimoxazole (52.5%).S.aureus isolates were resistant to penicillin (84.1%) and cotrimoxazole (51.1%).M.catarrhalis isolates were resistant to penicillin (94.6%), erythromycin (86.5%)and cotrimoxazole (78.4%). Overall, 99 (59.3%) of the isolates were multi-drug (MDR) resistant. The overall MDR rates among S.aureus, M.catarrhalis and S.pneumoniae isolates were 65.9%, 78.4% and 22.6%, respectively.ConclusionsPharyngeal colonization of respiratory bacteria in HIV infected children is a major public health problem. Single and multiple antibiotic resistant is alarmingly high among respiratory colonizers. Therefore, regular screening of HIV infected children for culture and antimicrobial susceptibility testing is recommended to prevent the development of severe opportunistic infections.

First data on antimicrobial susceptibility patterns of Moraxella catarrhalis isolates in Lebanon

“…On the other hand, our findings showed the emergence of resistance to trimethoprim-sulfamethoxazole (14.7%), and ciprofloxacin (2.9%). Various previous studies conducted globally reported the spread of resistance to trime thoprim-sulfamethoxazole among M. catarrhalis isolates, such as 12.5% in Tunisia [21], 13.8% in Australia [22] [20], and 100% in Iran [25]. Based on the aforementioned data, the spread of cotrimoxazole resistance among M. catarrhalis isolates in developing countries is shocking, and reveals a prominent threat jeopardizing the clinical efficacy of this important antibiotic.…”

“…Regrettably, tetracycline resistance has emerged in numerous developing and developed countries. The higher levels of resistance were reported in China [19], Taiwan [2] and Ethiopia [20]. Furthermore, several studies realized in developing countries indicated unexpected levels of antimicrobial resistance to erythromycin in M. ca-tarrhalis isolates, with 59.1% in Pakistan [13], 70.8% in China [19], and 86.6% in Ethiopia [20].…”

“…Moreover, the ciprofloxacin resistancewas detected for the first time among M. catarrhalis isolates in Lebanon, with a higher rate than that reported in the majority of countries. Surprisingly, two studies conducted in Ethiopia and Pakistan showed high level of resistance to ciprofloxacin, with 16.2% and 59% respectively [13,20]. Indeed, our generated data are in accordance with recent national studies reporting an increased level of antimicrobial resistance among infectious bacterial agents, a striking low level of antibiotic awareness among Lebanese population, a spread of counterfeit medicines, and a misuse of antibiotics in Lebanon [6][7][8][9][10][11][26][27][28][29][30][31][32].…”

The Variation Pattern and the Distribution Comparative Analysis of Bacterial Pathogenic Spectrum of Children from Different Age Groups and Adults

“…Our data are consistent with the ancient Chinese saying and the view of international scientists [7]: boys are more easily to be infected compared with girls. [9]. The related papers have reported that the separation rate is much higher for children than the adults [10].…”

“…This may affect children's immune function which is not fully mature, and can easily acquire acute upper respiratory tract infection. Respiratory pathogens in nasopharynx is closely related to factors such as the number of carrying rate and engraftment [9,10].…”