Journal Article

Typical pneumonia among human immunodeficiency virus-infected patients in public hospitals in southern Ethiopia

Raman, Gurusamy, Assefa, Ayele, Woldemariam, Melat, M. Alahmadi, Reham, Manilal, Aseer, Mohammed, Temesgen, Zakir, Abdurezak, Idhayadhulla, Akbar, Aklilu, Addis, Alelign, Dagninet

2024

Overview

Typical pneumonia is a pressing issue in the treatment of human immunodeficiency virus (HIV) patients, especially in Sub-Saharan Africa, where it remains a significant menace. Addressing this problem is crucial in improving health outcomes and the reduction of the burden of diseases in this vulnerable category of patients. To determine the prevalence of community-acquired typical pneumonia among HIV patients in Public Hospitals in southern Ethiopia. A cross-sectional study was done among 386 HIV patients clinically suspected of typical pneumonia attending the anti-retroviral therapy (ART) clinics of two hospitals from March to September 2022. A pretested structured questionnaire was employed to collect the demographic, clinical, and behavioral data. Sputum samples were collected and inspected for bacteria following standard procedures, and antimicrobial susceptibility testing was performed employing the Kirby-Bauer disk diffusion method. Besides, extended-spectrum β-lactamase (ESβL) and carbapenemase-producing Gram-negative bacteria were inspected by the double disk synergy test and modified carbapenem inactivation method. Descriptive and inferential statistical analyses were also done. Overall, 39.1% (151/386) of sputum cultures (95% Confidence Interval: 32.4-44) were bacteriologically positive. A total of 151 bacteria were identified, comprising 72.8% (n = 110) of Gram-negative bacteria. The predominant isolate was Klebsiella pneumoniae (25.8%, n = 39), followed by Staphylococcus aureus (17.9%, n = 27); 59.6% (n = 90) of the entire isolates were multidrug-resistant (MDR). Forty percent (11/27) of S. aureus were methicillin-resistant S. aureus (MRSA), and 28.1% (n = 31) and 20.9% (n = 23) of Gram-negative bacteria were extended-spectrum beta-lactamases (ESBL) and carbapenemase producers, respectively. Occupational status, alcohol consumption, cluster of differentiation4 (CD4) Thymocyte cell count < 350, interruption of trimethoprim-sulfamethoxazole prophylaxis and antiretroviral treatment, and recent viral load ≥ 150 were found statistically significant. The higher rates of MDR, MRSA, ESBL, and carbapenem-resistant Enterobacterales (CRE) indicate that bacterial pneumonia is a vexing problem among HIV patients and therefore it is advisable to implement an antimicrobial stewardship program in the study area.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / Adult / AIDS / Analysis / Anti-Bacterial Agents - pharmacology / Anti-Bacterial Agents - therapeutic use / Antibiotics / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Antiviral agents / Bacteria / Bacterial infections / Bacterial pneumonia / Beta lactamases / beta-Lactamases - metabolism / Biology and Life Sciences / Carbapenemase / Carbapenems / CD4 antigen / Cell differentiation / Cross-Sectional Studies / Disease susceptibility / Drug resistance / Drug resistance in microorganisms / Enterobacterales / Ethiopia - epidemiology / Female / Gram-negative bacteria / Health aspects / Health services / Highly active antiretroviral therapy / HIV / HIV (Viruses) / HIV Infections - complications / HIV Infections - drug therapy / HIV Infections - epidemiology / HIV Infections - microbiology / HIV patients / Hospitals / Hospitals, Public / Human immunodeficiency virus / Humans / Inactivation / Klebsiella / Klebsiella pneumoniae / Laboratories / Load distribution / Male / Medical research / Medicine and Health Sciences / Medicine, Experimental / Methicillin / Methicillin-Resistant Staphylococcus aureus - drug effects / Methicillin-Resistant Staphylococcus aureus - isolation & purification / Microbial Sensitivity Tests / Middle Aged / Multidrug resistance / Patients / Pneumonia / Pneumonia - drug therapy / Pneumonia - epidemiology / Pneumonia - microbiology / Prevalence / Prophylaxis / Public health / Research and Analysis Methods / Sputum / Sputum - microbiology / Staphylococcus aureus / Statistical analysis / Sulfamethoxazole / Tetracycline / Tetracyclines / Trimethoprim / Trimethoprim-sulfamethoxazole / Young Adult / β Lactamase