Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
PLoS One. 2024 Jul 30;19(7):e0307780. doi: 10.1371/journal.pone.0307780. eCollection 2024.
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.
典型肺炎是人类免疫缺陷病毒（HIV）患者治疗中的一个紧迫问题，尤其是在撒哈拉以南非洲地区，它仍然是一个重大威胁。解决这个问题对于改善这一弱势群体患者的健康结果和减少疾病负担至关重要。
确定埃塞俄比亚南部公立医院 HIV 患者中社区获得性典型肺炎的患病率。
2022 年 3 月至 9 月，对两家医院抗逆转录病毒治疗（ART）诊所临床疑似典型肺炎的 386 名 HIV 患者进行了横断面研究。采用经过预测试的结构化问卷收集人口统计学、临床和行为数据。按照标准程序采集痰液样本进行细菌检查，并采用 Kirby-Bauer 圆盘扩散法进行抗菌药物敏感性试验。此外，采用双圆盘协同试验和改良碳青霉烯灭活法检查产超广谱β-内酰胺酶（ESβL）和碳青霉烯类抗生素耐药革兰氏阴性菌。还进行了描述性和推断性统计分析。
总体而言，386 份痰培养物中有 39.1%（95%置信区间：32.4-44）为细菌学阳性。共鉴定出 151 种细菌，其中革兰氏阴性菌占 72.8%（n=110）。主要分离株为肺炎克雷伯菌（25.8%，n=39），其次为金黄色葡萄球菌（17.9%，n=27）；整个分离株中 59.6%（n=90）为多药耐药菌（MDR）。27 株金黄色葡萄球菌中有 40%（11/27）为耐甲氧西林金黄色葡萄球菌（MRSA），28.1%（n=31）和 20.9%（n=23）的革兰氏阴性菌分别为产超广谱β-内酰胺酶（ESBL）和产碳青霉烯酶菌。职业状况、饮酒、CD4 胸腺细胞计数<350、中断复方磺胺甲噁唑预防和抗逆转录病毒治疗以及最近的病毒载量≥150 与结果显著相关。
MDR、MRSA、ESBL 和碳青霉烯类抗生素耐药肠杆菌科（CRE）的高发生率表明，细菌性肺炎是 HIV 患者的一个棘手问题，因此建议在研究区域实施抗菌药物管理计划。
