Manipal College of Medical Sciences, Pokhara, Nepal.
Melaka Manipal Medical College, Manipal Academy of Higher Education, Manipal, India.
PLoS One. 2019 Feb 19;14(2):e0212042. doi: 10.1371/journal.pone.0212042. eCollection 2019.
A worldwide increase in the gastrointestinal colonization by extended-spectrum β-lactamase (ESBL)-producing bacteria has been observed. Their prevalence amongst Healthy People Living with HIV (HPLWH) has not been investigated adequately. The aim of this study was to determine and compare the rates of and risk factors for intestinal carriage and acquisition of extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-E) and carbapenemase-producing Enterobacteriaceae (CPE) among healthy people living with HIV (HPLWH) and healthy HIV negative population in the community. A cross-sectional study was conducted. Rectal swabs from HPLWH (n = 119) and HIV negative individuals (n = 357) from the community were screened for ESBL and CPE. Phenotypically confirmed ESBL-E strains were genotyped by multiplex PCR. The risk factors associated with ESBL-E colonization were analyzed by a multivariable conditional logistic regression analysis. Specimen from 357 healthy volunteers (213 female and 144 male) and 119 HPLWH (82 female and 37 male) with a median age of 30 [IQR 11-50] years were included in the study. ESBL colonization were found in 45 (37.82% [CI 29.09, 47.16]) and 246 (68.91% [CI 63.93, 73.49]), HPLWH and healthy HIV negative participants respectively. HPLWH had lower ESBL carriage rate (odds ratio 0.274 [CI 0.178, 0.423]) compared to healthy HIV negative subject's (p<0.01). In this study, no carbapenemase-producing bacteria were isolated.CTX-M-15 type was the most predominant genotype in both groups. Livestock contact and over-the-counter medications were significantly associated with a higher ESBL-E carriage rate among healthy subjects. This is the first study in Nepal that has demonstrated a high rate of gut colonization by ESBL-E in the community, predominantly of blaCTX-M-15 genotype. This study divulges the low fecal carriage rate of ESBL producing bacteria in HPLWH group compared to healthy individuals in western Nepal. The factors responsible for this inverse relationship of HIV status and gut colonization by ESBL-E are unidentified and require further large-scale study.
目前，已观察到全球范围内肠道中产超广谱β-内酰胺酶（ESBL）的细菌定植率有所增加。然而，HIV 感染者（HPLWH）中此类细菌的流行情况尚未得到充分研究。本研究旨在确定和比较社区中 HIV 感染者（HPLWH）和健康 HIV 阴性人群中肠道产 ESBL 肠杆菌科（ESBL-E）和产碳青霉烯酶肠杆菌科（CPE）的携带率和获得率，并分析其相关危险因素。本研究为横断面研究。对社区中 HPLWH（n=119）和 HIV 阴性个体（n=357）的直肠拭子进行 ESBL 和 CPE 筛查。采用多重 PCR 对表型确认的 ESBL-E 菌株进行基因分型。采用多变量条件逻辑回归分析来分析与 ESBL-E 定植相关的危险因素。研究共纳入 357 名健康志愿者（213 名女性和 144 名男性）和 119 名 HPLWH（82 名女性和 37 名男性）的标本，中位年龄为 30 岁[IQR 11-50]岁。ESBL 定植分别在 45（37.82%[95%CI 29.09, 47.16]）和 246（68.91%[95%CI 63.93, 73.49]）名 HPLWH 和健康 HIV 阴性参与者中发现。与健康 HIV 阴性参与者相比，HPLWH 的 ESBL 携带率较低（比值比 0.274[95%CI 0.178, 0.423]）（p<0.01）。在本研究中，未分离出产碳青霉烯酶的细菌。CTX-M-15 型是两组中最主要的基因型。家畜接触和非处方药物与健康受试者中 ESBL-E 携带率的升高显著相关。这是尼泊尔首例研究，表明社区中产 ESBL-E 的肠道定植率较高，主要为 blaCTX-M-15 基因型。本研究表明，与尼泊尔西部的健康个体相比，HPLWH 组产 ESBL 细菌的粪便携带率较低。造成 HIV 状态与 ESBL-E 肠道定植呈反比关系的原因尚不清楚，需要进一步进行大规模研究。
