Abstract:
Background: Extended spectrum beta lactamase (ESBL) producing Enterobacteriaceae (ESBL-PE) are a group of bacteria that are resistant to a conventional therapy, in particular third generation cephalosporins, fluoroquinolones and penicillins. Currently, there are growing evidences indicating that drug resistant bacteria notably ESBL-PE is greatly implicated in immune-compromised groups namely individuals with HIV infection. However, little is known about the burden of ESBL-PE in places where HIV infection is rampant.
Objective: To assess the prevalence, antimicrobial resistance pattern of ESBL-PE among HIV/AIDS patients at the University of Gondar hospital, North-west Ethiopia.
Method: A cross-sectional study was conducted among HIV/AIDS patients seeking ART service at the University of Gondar Hospital ART clinic from February-May, 2017. Pre-tested and structured questionnaire was used to collect data on socio-demographic and clinical related factors. Clean catch mid-stream urine samples were collected and cultured in line with standard procedures. The drug susceptibility testing was performed by Kirby Bauer disc diffusion method. ESBL detection was performed using double disc synergy test and combined disc methods. Data entry and analysis was performed using SPSS version 20.
Result: Among a total of 387 HIV/AIDS patients, 42 (10.9%) Enterobacteriaceae uropathogens were recovered. Of these isolates, nine (21.4%) were ESBL producers. The highest prevalence of ESBL production was noted in E.coli (44.4%) followed by K.pneumoniae (22.2%) and Enterobacter spp. (22.2%). Higher drug resistance rates were observed among ESBL producing isolates compared to ESBL non producing isolates. The ESBL-PEs demonstrated no resistance to Nitrofurantoin, whereas high resistance rates were noted to Amox-clavulanic (100%), Ampicillin (95%), Cotrimoxazole (74%), cefotaxime (88.9%) and ceftazidime (88.9%). The overall prevalence of multidrug resistance of all isolates was 92.9% and all ESBL isolates were multidrug resistant
Conclusion and Recommendation: Considerably, high prevalence of ESBL-PE was observed in HIV patients. E. coli and K. pneumonia were the most prevalent ESBL producers. All ESB-PE isolates were MDR for all tested antimicrobial agents. Antibiotic resistance rates in ESBL-PE isolates were significantly higher than other ESBL non producing isolates Therefore, antimicrobial stewardship programs needed to be promoted for rational use of drugs especially in the management of HIV/AIDS patients.
