Abstract
BackgroundPeople living with HIV may be at increased risk for infections with resistant organisms. Infections with ESBL-producing organisms are of particular concern because they limit treatment options for severe Gram-negative infections in low-resource settings.ObjectivesTo investigate the association between HIV status and urinary tract infections (UTIs) with ESBL-producing Escherichia coli.Patients and methodsCross-sectional study enrolling adults presenting with UTI symptoms to primary care clinics in Harare, Zimbabwe. Demographic and clinical data were collected during interviews and a urine sample was collected for culture from each participant. Antimicrobial susceptibility testing was performed according to EUCAST recommendations.ResultsOf the 1164 who were enrolled into the study, 783 (64%) were female and 387 (33%) were HIV infected. The median age was 35.8 years. Urine cultures were positive in 338 (29.0%) participants, and the majority of bacterial isolates were E. coli (n = 254, 75.2%). The presence of ESBL was confirmed in 49/254 (19.3%) E. coli. Participants with HIV had a 2.13 (95% CI 1.05–4.32) higher odds of infection with ESBL-producing E. coli than individuals without HIV. Also, the prevalence of resistance to most antimicrobials was higher among participants with HIV.ConclusionsThis study found an association between HIV and ESBL-producing E. coli in patients presenting with symptoms suggestive of UTI to primary care in Harare. HIV status should be considered when prescribing empirical antimicrobial treatment.
Highlights
The increase in antimicrobial resistance (AMR) challenges our ability to effectively treat infections leading to excess morbidity and mortality.[1]
AMR has been highlighted as a priority on the global health agenda,[2] surveillance data on the burden of AMR are lacking from many low- and middle-income countries (LMICs).[3]
In understanding the burden of AMR, specific attention needs to be paid to populations who may be at increased risk for infections with resistant organisms such as people living with HIV
Summary
The increase in antimicrobial resistance (AMR) challenges our ability to effectively treat infections leading to excess morbidity and mortality.[1]. In understanding the burden of AMR, specific attention needs to be paid to populations who may be at increased risk for infections with resistant organisms such as people living with HIV. There are currently 38 million people living with HIV; two-thirds in sub-Saharan Africa.[4] there is evidence of an association between HIV and infection and colonization with resistant organisms, research has mainly focused on Gram-positive pathogens while data for Gram-negative infections are sparse.[5,6,7]. ESBL-producing Gram-negative organisms are of particular concern in LMICs. ESBLs confer resistance to third-generation. People living with HIV may be at increased risk for infections with resistant organisms. Infections with ESBL-producing organisms are of particular concern because they limit treatment options for severe Gram-negative infections in low-resource settings
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