Abstract
Colonization in HIV-infected populations with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) is particularly worrisome in low-income settings. This study describes the prevalence of ESBL-PE carriage and associated risk factors among newly HIV-diagnosed adults in a community setting in Tanzania. A total of 595 newly diagnosed HIV adults with a median age of 35 years with interquartile range (IQR) 29–42 years and a median CD4 count of 492 cells/μL (IQR 390–666 cells/μL) were recruited. Among these, 194/595 (32.6%, 95% confidence interval [CI] 28.9–36.6) were ESBL-PE carriers. Participants with low CD4 count (<350 cells/μL) had significantly higher prevalence of ESBL-PE carriage compared with those with CD4 count ≥350 cells/μL (26/58, 44.8%, vs. 168/537, 31.3%, p = 0.04). Antibiotic use in last 4 weeks (odds ratio [OR] 1.55, 95% CI 1.08–2.22, p = 0.02) and CD4 count ≥350 cells/μL (OR 1.78, 95% CI 1.03–3.09, p = 0.04) were independent risk factors for fecal carriage of ESBL-PE. In total, 244 isolates of ESBL-PE were isolated from 194 participants. Of these, 238/244 (97.5%) harbored blaCTX-M genes, with blaCTX-M-15 being predominant (219/238 (92%), followed by blaCTX-M-27 (9/238 (3.8%), blaCTX-M-14 (8/238 (3.4%), blaCTX-M-55 (1/238), and blaCTX-M 211/3 (1/238). blaSHV-2a genes were detected in four isolates, whereas the blaSHV-12 gene was detected in one isolate. Phenotypic carbapenemase-producing Enterobacteriaceae was detected in one HIV-positive person with CD4 count 132 cells/μL. In conclusion prevalence of ESBL-PE carriage is high among newly diagnosed HIV adults in Dar es Salaam, and is significantly associated antibiotic use and low CD4 count.
Highlights
Individuals living with HIV are at risk of classical HIV-related opportunistic infections such as pneumocystis pneumonia and tuberculosis, and severe infections caused by common bacterial pathogens such as Escherichia coli, salmonella, pneumococci, and staphylococci.[1,2,3]
Infections caused by Extended-spectrum blactamase-producing Enterobacteriaceae (ESBL-PE) carries high mortality exceeding mortality outcome of bacterial infections in the preantibiotic era.[5,8]
This rate of ESBL-PE fecal carriage is much higher than found among adults with unknown HIV status in community-based studies in Northern Tanzania (55/334, 16.5%, p < 0.001),[16] Burkina Faso (22/101, 21.8%, p = 0.03),[21] Gambia (28/565, 5.0%, p < 0.001),[22] and Morocco (4/93, 4.3%, p < 0.001).[23]
Summary
Individuals living with HIV are at risk of classical HIV-related opportunistic infections such as pneumocystis pneumonia and tuberculosis, and severe infections caused by common bacterial pathogens such as Escherichia coli, salmonella, pneumococci, and staphylococci.[1,2,3] The World Health Organization (WHO) recognizes antimicrobial resistance (AMR) in such bacterial infections as a major threat to global health. Extended-spectrum blactamase-producing Enterobacteriaceae (ESBL-PE) constitute a particular challenge, as almost all are multidrug resistant. Infections due to ESBL producers were mainly a health care-associated problem.[4,5] ESBL-PE infections are increasingly acquired in the community.[6,7]. In resource-constrained settings, ESBL-PE infections are spread more due to deficient infection control, whereas expensive reserve antibiotics such as carbapenems and colistin are inaccessible. Infections caused by ESBL-PE carries high mortality exceeding mortality outcome of bacterial infections in the preantibiotic era.[5,8]
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