Abstract
Urinary tract infection remains a major public health problem in developing countries, where there are limited health-care services. Its prevalence is fueled by human immunodeficiency virus (HIV) infection. The emergence of antimicrobial resistance is now widespread and poses a serious clinical threat. This study investigated the prevalence, antimicrobial susceptibility pattern of bacterial isolates, and associated factors of urinary tract infections among HIV-positive adult patients. A cross-sectional study was conducted among 350 randomly selected HIV-positive patients at Hiwot Fana Specialized University Hospital from February to March 2016. Data were collected using a structured questionnaire. Clean-catch midstream urine samples were collected aseptically and examined using the recommended culture methods. Antimicrobial susceptibility testing was performed using the Kirby–Bauer disk diffusion technique. Data were analyzed using Statistical Package for the Social Sciences version 21.0. The logistic regression models were used to explore the predictors of the outcome. A p value < 0.05 was considered statistically significant. The overall prevalence of urinary tract infection was 18% (95% CI: 15.34–22.63). Individuals with age 35–44 years (Adjusted odds ratio (AOR): 4.07; 95% CI: 1.09, 5.10), income less than 46.7 USD (AOR: 2.76; 95% CI: 1.15, 6.07), and a CD4+ count less than 200 cells/mm3 (AOR: 2.07; 95% CI: 1.15, 3.73) had higher odds of UTI. Escherichia coli (38.1%), Klebsiella pneumoniae (23.8%), and Staphylococcus aureus (11.1%) were the predominant causes of urinary tract infection. E. coli was resistant to ampicillin (95.8%), ceftazidime (95.8%), cotrimoxazole (95.8%), amoxicillin (91.7%), ceftriaxone (87.5%), and tetracycline (87.2%). Multidrug resistance was observed in 46% of the isolates. The prevalence of urinary tract infection in this study was high compared to the previous reports in Ethiopia. Age 35–44 years, income less than 46.7 USD, and a CD4+ count < 200 cells/mm3 increase the odds of urinary tract infection. The most common isolates were E. coli, K. pneumoniae, and S. aureus. Almost half of the isolates were multidrug resistant. Actions to help mitigate the further spread of resistance are urgently needed in the study area.
Highlights
Urinary tract infection (UTI) is caused by the bacterial invasion and multiplication in the organs of the urinary tract system [1]. e frequency of UTI is gradually increasing amongst human immunodeficiency virus (HIV)-infected patients as an opportunistic infection. is is due to the unique pathogenesis of the virus, which decreases the CD4+ cells, and as such, the individual’s immune system can no longer fight against invading commensal organisms [2,3,4]
Most participants had a primary level education (1st–8thgrade) (45.4%), were currently married (61.4%), and were merchants (38.6%). e average monthly income of the participants was less than 46.7 United States Dollar (USD) per month (49.7%) (Table 1)
Out of the 350 samples, bacteria were isolated from 63 samples giving an overall prevalence of 18%. e majority (77.8%) of isolates were Gram-negative bacteria
Summary
Urinary tract infection (UTI) is caused by the bacterial invasion and multiplication in the organs of the urinary tract system [1]. e frequency of UTI is gradually increasing amongst HIV-infected patients as an opportunistic infection. is is due to the unique pathogenesis of the virus, which decreases the CD4+ cells, and as such, the individual’s immune system can no longer fight against invading commensal organisms [2,3,4]. Urinary tract infection (UTI) is caused by the bacterial invasion and multiplication in the organs of the urinary tract system [1]. E health consequences of UTI among HIV-infected patients can be grave, resulting in acute and chronic kidney diseases [7], infertility, cancer, sepsis, and neurologic. Some of the patients may substantially suffer from financial burden because of the recurrence of UTI and due to the use of expensive antimicrobials, longer duration hospitalization, adverse drug effects, and unsatisfactory therapeutic options [7, 10]. In Ethiopia, limited studies are available regarding the extent of UTI and antimicrobial susceptibility profile in HIV-positive patients [2, 12]. Is study investigated the prevalence, antimicrobial susceptibility pattern, and associated factors of bacterial UTI among HIV-positive adult patients at Hiwot Fana Specialized University Hospital, Eastern Ethiopia E emergence of antimicrobial-resistant bacterial strains that poses a continued challenge to treat and control the spread of infections is another concern [10]. e problem is immense in developing countries such as Ethiopia that do not have quality laboratory facilities to isolate pathogens and determine their antimicrobial susceptibility pattern, but with high fake drugs in circulation, misuse of antimicrobials by health-care providers, unskilled practitioners, and patients are common [2, 11].
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