埃塞俄比亚贡德尔大学综合专科医院感染艾滋病毒的儿童中产超广谱β-内酰胺酶肠杆菌科的粪便携带情况。
Fecal carriage of extended spectrum beta-lactamase producing Enterobacteriaceae among HIV infected children at the University of Gondar Comprehensive Specialized Hospital Gondar, Ethiopia.
机构信息
Department of Clinical Hematology and Immunohematology, College of Medicine and Health Sciences, University of Gondar, 196, Gondar, Ethiopia.
Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
出版信息
AIDS Res Ther. 2021 Apr 21;18(1):19. doi: 10.1186/s12981-021-00347-x.
BACKGROUND
Human immunodeficiency virus (HIV) and extended spectrum beta lactamase (ESBL) producing Enterobacteriaceae infections are the major challenges in sub-Saharan Africa. Data on the carriage rate of ESBL producing Enterobacteriaceae among HIV infected children is lacking in Ethiopia. Hence this study was aimed to investigate fecal carriage of ESBL producing Enterobacteriaceae among HIV infected children at the University of Gondar comprehensive Specialized Hospital.
METHODS
A cross-sectional study was conducted among HIV infected children from January to April 2020. Stool specimens were collected from 161 study participants by convenient sampling and cultured on MacConkey agar. Biochemical identification, antimicrobial susceptibility testing including ESBL production were carried out. Data were analyzed by SPSS version-20 and P-value < 0.05 on multivariate logistic regression analysis was regarded as statistically significant.
RESULTS
From a total of 161 study participants male to female ratio was 1:1.1. Moreover; 96.3% of participants were in HIV stage-I and 90.1% had at least a year highly active antiretroviral therapy exposure. A total of 186 Enterobacteriaceae, with E. coli 60% and K. pneumonia 16.13% predominance were isolated from 161 participants. Majority of isolates were most resistant to amoxicillin (95.1%) and sensitive to CHL (94.1%), CXT (91.4%) and CAZ (91.4%). There were 71(38.17%) multidrug resistant isolates, 13 of which were also ESBL producers. The overall ESBL carriage rate was 32/161 (19.9%). History of antibiotic use was the independent factor associated with ESBL carriage (AOR 3.23 (95% CI 1.054-9.88)) and P-value of 0.04.
CONCLUSION
ESBL carriage rate of HIV infected children was considerable. Previous antibiotic use was the independent factor. Regular screening for antibiotic resistance on HIV patients before prescription and large-scale antibiotic resistance survey including healthy community may be important.
背景
在撒哈拉以南非洲地区，人类免疫缺陷病毒（HIV）和产extended spectrum beta lactamase（ESBL）的肠杆菌科细菌感染是主要挑战。在埃塞俄比亚，HIV 感染儿童中产 ESBL 的肠杆菌科细菌携带率的数据尚不清楚。因此，本研究旨在调查贡德尔大学综合专科医院 HIV 感染儿童中 ESBL 产肠杆菌科细菌的粪便携带率。
方法
这是一项 2020 年 1 月至 4 月期间进行的 HIV 感染儿童的横断面研究。采用便利抽样法从 161 名研究参与者中采集粪便标本，并在 MacConkey 琼脂上培养。进行了生化鉴定、抗菌药物敏感性试验，包括 ESBL 产生情况。采用 SPSS 版本 20 进行数据分析，多变量逻辑回归分析中 P 值<0.05 被认为具有统计学意义。
结果
在总共 161 名研究参与者中，男女比例为 1:1.1。此外，96.3%的参与者处于 HIV 期 I，90.1%的参与者接受了至少一年的高效抗逆转录病毒治疗。从 161 名参与者中分离出 186 株肠杆菌科细菌，其中大肠杆菌占 60%，肺炎克雷伯菌占 16.13%。大多数分离株对阿莫西林的耐药性最高（95.1%），对 CHL（94.1%）、CXT（91.4%）和 CAZ（91.4%）的敏感性最高。有 71 株（38.17%）多药耐药株，其中 13 株也是 ESBL 生产者。总的 ESBL 携带率为 32/161（19.9%）。抗生素使用史是与 ESBL 携带相关的独立因素（AOR 3.23（95%CI 1.054-9.88）），P 值为 0.04。
结论
HIV 感染儿童的 ESBL 携带率相当高。先前使用抗生素是独立的因素。在开具处方前对 HIV 患者进行抗生素耐药性常规筛查，以及包括健康社区在内的大规模抗生素耐药性调查可能很重要。
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