Bacterial Profile and their Antibiotic Resistance Pattern among HIV Patients Diagnosed with Pneumonia in Felege-Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia

Abstract

Background: Bacterial pneumonia remains the major cause of morbidity and admission diagnosis among human immunodeficiency virus-infected individuals. In the study area, data about the bacterial profile of pneumonia and their antimicrobial resistance pattern among people living with human immunodeficiency virus is limited. Hence, this study was aimed to estimate the prevalence of bacterial pneumonia, antibiotic resistance patterns of isolated bacteria, and associated factors among HIV patients in Felege Hiwot Referral Hospital. Method: A Hospital-based cross-sectional study was conducted from February 15 to June 15, 2019. Sputum specimens were collected from 163 pneumonia presumptive HIV seropositive individuals. Data on socio-demographic characteristics and risk factors were also collected using a structured questionnaire. Blood, Chocolate, and MacConkey agar plates were used to grow the isolates. The isolated colonies were identified based on Gram Stain, colony morphology, hemolysis, and biochemical tests. The antimicrobial susceptibility test was performed using the modified Kirby-Bauer Disc Diffusion method. Descriptive and multivariate analyses were performed using SPSS version 23. P-value < 0.05 was considered statistically significant. Result: Out of 163 sputum samples, 68 (41.7%) were culture positive for common bacterial infections. The predominant bacterial isolates were Klebsiella pneumoniae 19 (27.9%), and Staphylococcus aureus, 17 (25%). From multivariate analysis, age groups 18-29 (AOR = 5.4, 95 % CI: 1.26-23.35), age groups 30-39 (AOR = 3.8, 95% CI: 1.03 13.80), recent viral load greater than or equal to 150 copies/ml (AOR= 24.3, 95 % CI: 2.61-56.38), viral load less than 150 copies/ml (AOR= 5.1, 95% CI: 1.26-21.04), cigarette smoking (AOR=15.5, 95% CI: 1.61-48.59), and alcohol consumption (AOR=8.1, 95% CI: 2.76-23.51) were found to have statistically significant association with bacterial pneumonia. Out of the tested antibiotics, 46 (70.8%) were resistant to cotrimoxazole and P. aeruginosa were 100% resistant to gentamycin and ceftazidime. Overall, 77.9% of the isolates were MDR. Conclusion: The study showed a high prevalence of bacterial pneumonia and a high percentage of drug resistance including MDR in the study area. Therefore, we recommend that culture and antimicrobial susceptibility tests should be routinely performed for the selection of appropriate treatment.

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

“…This report presents the first accounts of the prevalence and bacterial profile of typical pneumonia among HIV patients in Arba Minch. The HIV patients in our study area experienced high rates of typical pneumonia, with an overall prevalence of 39.1% (95% CI: 32.4–44), and is consistent with a couple of earlier studies done in the country (Bahirdar (41.7%) and Mekele (43.7%)) [ 4 , 13 ]. A higher prevalence rate might be ascribed to reduced protective immunity, enhancing the vulnerability to respiratory infections [ 11 ].…”

“…All participants were given a clear explanation of the purpose of the study, and each one of them submitted informed consent prior to data and specimen collection. A structured questionnaire was developed and utilized [ 4 , 11 , 13 ] through face-to-face interviews to gather information on patient-related socio-demographic characteristics and behavioral factors. The data on clinical and immunological laboratory variables (CD 4 T-cell counts, viral load (HIV-1 RNA copies/mL), HIV stage, duration of HIV, etc) were collected after referring the patient’s medical records.…”

“…Earlier studies have shown that several factors are linked with the incidence of pneumonia among HIV patients. The critical risk factors connected to bacterial pneumonia are recent CD 4 T cell count ≤350 cells/mm 3 , alcoholism, HIV-World Health Organization (WHO) Stage II, a viral load ≥ 150 copies/mL, smoking, old age, and cooking food using firewood in the living room [ 4 , 11 , 13 ]. Therefore, identifying these factors may provide a practical and theoretical basis for the implementation of preventive measures and targeted interventions.…”

“…It is worth noting that respiratory tract infections account for the majority of antibiotic prescriptions worldwide. A higher level of antimicrobial resistance is reported in bacteria isolated from HIV patients with pneumonia [ 13 ], and hence, they must follow a specific regimen [ 14 ]. In Africa, HIV patients often suffer from comorbid illnesses such as respiratory infections, with bacterial pneumonia being the most prevalent and fatal [ 15 ].…”

“…In Ethiopia, opportunistic infections are responsible for over 90% of HIV/AIDS-related deaths, with bacterial pneumonia being the leading cause [ 18 ]. Nevertheless, a national data bank on the prevalence of opportunistic infections among HIV/AIDS patients in the country is sorely lacking; studies conducted in selected regions have shown that bacterial pneumonia occurs among HIV patients, and it ranges from 41.7 to 43.7% [ 4 , 13 ]. Typical pneumonia is considered one of the most prevailing opportunistic bacterial infections among HIV patients in the area under study.…”