Nontyphoidal bacteremia in antiretroviral therapy-naïve HIV-infected individuals at three public hospitals in Eastern Ethiopia: prevalence, antimicrobial susceptibility patterns, and associated factors.

BACKGROUND

Nontyphoidal bacteria have emerged as the prominent cause of severe and life-threatening bacteremia in HIV-infected patients. Antimicrobial resistance is another concern that adversely affects the health outcome of the patients. This study investigated the prevalence, antimicrobial susceptibility pattern of the isolates, and associated factors of nontyphoidal bacteremia among antiretroviral therapy-naïve HIV-infected adult individuals at three public hospitals in Eastern Ethiopia.

METHODS

A cross-sectional study was conducted among 170 antiretroviral therapy-naïve HIV-infected adult individuals in three public hospitals in Eastern Ethiopia from June 2017 to June 2018. Data on sociodemographic and associated factors were collected using a pretested structured questionnaire. Blood specimens were examined for nontyphoidal using the recommended culture and serological methods. Data were analyzed using the Statistical Package for Social Sciences version 20.0. Bivariate and multivariate logistic regression models were used to identify the predictors of nontyphoidal bacteremia. A -value <0.05 was considered as statistically significant.

RESULTS

The prevalence of nontyphoidal bacteremia was 10% (95% CI: 5.93-15.54). A lack of hand washing habit before food preparation (adjusted odds ratio [AOR]: 13.1, 95% CI: 10.40-15.30) and a CD4 count <200 cells/µL (AOR: 3.61, 95% CI: 1.74-5.25) were found to be significantly associated with nontyphoidal bacteremia. Most isolates were sensitive to gentamycin (76.5%), ciprofloxacin (70.5%), and ceftriaxone (58.8%), but resistant to tetracycline (88.2%), chloramphenicol (76.5%), ampicillin (70.6%), and sulfamethoxazole-trimethoprim (70.6%).

CONCLUSION

The prevalence of nontyphoidal bacteremia was high. HIV-infected patients who did not wash their hands before food preparation and those whose CD4 count was <200 cells/µL had significantly higher odds of nontyphoidal bacteremia. Tetracycline, chloramphenicol, ampicillin, and sulfamethoxazole-trimethoprim should not be used for the treatment of nontyphoidal bacteremia. The treatment needs to be supported by culture isolation and antimicrobial susceptibility tests.