Abstract
A worldwide increase in the gastrointestinal colonization by extended-spectrum β-lactamase (ESBL)-producing bacteria has been observed. Their prevalence amongst Healthy People Living with HIV (HPLWH) has not been investigated adequately. The aim of this study was to determine and compare the rates of and risk factors for intestinal carriage and acquisition of extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-E) and carbapenemase-producing Enterobacteriaceae (CPE) among healthy people living with HIV (HPLWH) and healthy HIV negative population in the community. A cross-sectional study was conducted. Rectal swabs from HPLWH (n = 119) and HIV negative individuals (n = 357) from the community were screened for ESBL and CPE. Phenotypically confirmed ESBL-E strains were genotyped by multiplex PCR. The risk factors associated with ESBL-E colonization were analyzed by a multivariable conditional logistic regression analysis. Specimen from 357 healthy volunteers (213 female and 144 male) and 119 HPLWH (82 female and 37 male) with a median age of 30 [IQR 11–50] years were included in the study. ESBL colonization were found in 45 (37.82% [CI 29.09, 47.16]) and 246 (68.91% [CI 63.93, 73.49]), HPLWH and healthy HIV negative participants respectively. HPLWH had lower ESBL carriage rate (odds ratio 0.274 [CI 0.178, 0.423]) compared to healthy HIV negative subject’s (p<0.01). In this study, no carbapenemase-producing bacteria were isolated.CTX-M-15 type was the most predominant genotype in both groups. Livestock contact and over-the-counter medications were significantly associated with a higher ESBL-E carriage rate among healthy subjects. This is the first study in Nepal that has demonstrated a high rate of gut colonization by ESBL-E in the community, predominantly of blaCTX-M-15 genotype. This study divulges the low fecal carriage rate of ESBL producing bacteria in HPLWH group compared to healthy individuals in western Nepal. The factors responsible for this inverse relationship of HIV status and gut colonization by ESBL-E are unidentified and require further large-scale study.
Highlights
Antimicrobial resistance has become a serious threat worldwide due to the global emergence of new resistance mechanisms, and limited drugs available for treatment
ESBLs are the enzymes produced by bacteria that degrade extended spectrum β-lactam antibiotics such as third-generation cephalosporins, which are extensively used for the treatment of several systemic infections
Limited availability of antibiotics for treating patients infected by ESBL and carbapenemase producing members of Enterobacteriaceae (CPE) producing bacteria represents a great concern for healthcare
Summary
Antimicrobial resistance has become a serious threat worldwide due to the global emergence of new resistance mechanisms, and limited drugs available for treatment. Multidrug-resistant bacteria like extended spectrum β-lactamase (ESBL) and carbapenemase producing members of Enterobacteriaceae (CPE), along with methicillin resistant Staphylococcus aureus (MRSA), and vancomycin resistant Enterococcus (VRE) are emerging pathogens around the globe [1]. Infections by these organisms often end with grave clinical outcomes and consume much of the health-care resources. Gastrointestinal colonization with ESBL-producing Enterobacteriaceae (ESBL-E) may serve as an important reservoir and source of infections [2,3] Such resistant gut flora can no longer be considered as innocent bystanders. The CTX-M-1 phylogroup includes CTX-M-15 which is the most prevalent globally, probably evolving towards causing a global pandemic due to its carriage by members of the Enterobacteriaceae family [5]
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