Skip to main content
Top
Published in:

Open Access 01-12-2017 | Research

The common enteric bacterial pathogens and their antimicrobial susceptibility pattern among HIV-infected individuals attending the antiretroviral therapy clinic of Hawassa university hospital, southern Ethiopia

Authors: Ayele Kebede, Solomon Aragie, Techalew Shimelis

Published in: Antimicrobial Resistance & Infection Control | Issue 1/2017

Login to get access

Abstract

Background

The frequent occurrence of bacterial gastroenteritis among HIV-infected individuals together with increased antimicrobial drug resistance pose a significant public health challenge in developing countries. This study aimed to determine the prevalence of enteric bacterial pathogens and their antimicrobial susceptibility pattern among HIV-infected patients in a tertiary hospital in southern Ethiopia.

Methods

A hospital-based cross-sectional study was conducted at Hawassa University Comprehensive Specialized Hospital from February to May, 2016. A consecutive 215 HIV-infected patients, with complaints of gastrointestinal tract disease, were enrolled. Data on socio-demography and related factors was collected using a structured questionnaire. A stool sample was collected from each study participant and cultured to isolate enteric bacterial pathogens; isolates were characterized using biochemical tests. Antimicrobial susceptibility was determined using the Kirby- Bauer disk diffusion technique.

Results

Out of 215 patients, 27(12.6%) were culture positive for various bacterial pathogens. Campylobacter species was the most common bacterial isolate (6.04%), followed by Salmonella species (5.1%). The majority of isolates was sensitive to norfloxacin, nalidixic acid, gentamicin, ceftriaxone and ciprofloxacin and showed resistance to trimethoprim sulfamethoxazole (SXT) and chloramphenicol. Consumption of raw food was the only risk factor found to be significantly associated with enteric bacterial infection (crude odds ratio 3.41 95% CI 1.13–10.3).

Conclusions

The observed rate of enteric bacterial pathogens and their antimicrobial resistance pattern to the commonly prescribed antibiotics highlights the need to strengthen intervention efforts and promote rational use of antimicrobials. In this regard, the need to strengthen antimicrobial stewardship efforts should be emphasized to slow grown antimicrobial resistance among this population group.
Literature
1.
go back to reference Kallings LO. The first postmodern pandemic: 25 years of HIV/ AIDS. J Intern Med. 2008;263:18–43.CrossRef Kallings LO. The first postmodern pandemic: 25 years of HIV/ AIDS. J Intern Med. 2008;263:18–43.CrossRef
2.
go back to reference Cárcamo C, Hooton T, Wener MH, Weiss NS, Gilman R, Arevalo J. Etiologies and manifestations of persistent diarrhea in adults with HIV-1 infection: a case-control study in lima, Peru. JID. 2005;191:11–9.CrossRefPubMed Cárcamo C, Hooton T, Wener MH, Weiss NS, Gilman R, Arevalo J. Etiologies and manifestations of persistent diarrhea in adults with HIV-1 infection: a case-control study in lima, Peru. JID. 2005;191:11–9.CrossRefPubMed
3.
go back to reference Datta D, Gazzard B, Stebbing J. The diagnostic yield of stool analysis in 525 HIV-1-infected individuals. AIDS. 2003;17:1711–3.CrossRefPubMed Datta D, Gazzard B, Stebbing J. The diagnostic yield of stool analysis in 525 HIV-1-infected individuals. AIDS. 2003;17:1711–3.CrossRefPubMed
4.
go back to reference Sanchez TH, Brooks JT, Sullivan PS, Juhasz M, Mintz E, Dworkin MS. Bacterial diarrhea in persons with HIV infection, United States. Clin Infect Dis. 2005;41:1621–2.CrossRefPubMed Sanchez TH, Brooks JT, Sullivan PS, Juhasz M, Mintz E, Dworkin MS. Bacterial diarrhea in persons with HIV infection, United States. Clin Infect Dis. 2005;41:1621–2.CrossRefPubMed
5.
go back to reference Davies NECG, Karstaedt AS. Shigella bacteremia over a decade in Soweto, South Africa. Trans R Soc Trop Med Hyg. 2008;102:1269–73.CrossRefPubMed Davies NECG, Karstaedt AS. Shigella bacteremia over a decade in Soweto, South Africa. Trans R Soc Trop Med Hyg. 2008;102:1269–73.CrossRefPubMed
6.
go back to reference Fernández-Cruz A, Muñoz P, Mohedano R, Valerio M, Marin M, Alcala L. Campylobacter bacteremia clinical characteristics, incidence, and outcome over 23 years. Medicine. 2010;89:319–30.CrossRefPubMed Fernández-Cruz A, Muñoz P, Mohedano R, Valerio M, Marin M, Alcala L. Campylobacter bacteremia clinical characteristics, incidence, and outcome over 23 years. Medicine. 2010;89:319–30.CrossRefPubMed
7.
go back to reference Carcamo C, Hooton T, Wener MH, Weiss NS, Gilman R, Arevalo J, Carrasco J, Seas C, Caballero M, Holmes KK. Etiologies and manifestations of persistent diarrhea in adults with HIV-1 infection: a case-control study in lima, Peru. J Infect Dis. 2005;191(1):11–9.CrossRefPubMed Carcamo C, Hooton T, Wener MH, Weiss NS, Gilman R, Arevalo J, Carrasco J, Seas C, Caballero M, Holmes KK. Etiologies and manifestations of persistent diarrhea in adults with HIV-1 infection: a case-control study in lima, Peru. J Infect Dis. 2005;191(1):11–9.CrossRefPubMed
8.
go back to reference Call SA, Heudebert G, Saag M, Wilcox C. The changing etiology of chronic diarrhea inHIV-infected patients with CD4 cell counts less than 200 cells/mm3. AJG. 2000;95:3142–6.CrossRefPubMed Call SA, Heudebert G, Saag M, Wilcox C. The changing etiology of chronic diarrhea inHIV-infected patients with CD4 cell counts less than 200 cells/mm3. AJG. 2000;95:3142–6.CrossRefPubMed
9.
go back to reference Rossit ARB, Gonçalves ACM, Franco C, RLD M. Etiological agents of diarrhea in patients infected by the HIV-1. a review. Rev Inst Med trop S Paulo. 2009;5:59–65.CrossRef Rossit ARB, Gonçalves ACM, Franco C, RLD M. Etiological agents of diarrhea in patients infected by the HIV-1. a review. Rev Inst Med trop S Paulo. 2009;5:59–65.CrossRef
10.
go back to reference Kownhar H, Shankar EM, Rajan R, Vengatesan A, Rao UA. Prevalence of campylobacter jejuniand enteric bacterial pathogens among hospitalized HIV- infected versus non-HIVinfected patients with diarrhoea in southern India. Scand J Infect Dis. 2007;39:862–6.CrossRefPubMed Kownhar H, Shankar EM, Rajan R, Vengatesan A, Rao UA. Prevalence of campylobacter jejuniand enteric bacterial pathogens among hospitalized HIV- infected versus non-HIVinfected patients with diarrhoea in southern India. Scand J Infect Dis. 2007;39:862–6.CrossRefPubMed
11.
12.
go back to reference Awole M, Gebre-Selassie S, Kassa T, Kibru G. Isolation of potential bacterial pathogens from the stool of HIV-infected and HIV-non-infected patients and their antimicrobial susceptibility patterns in Jimma hospital, south west Ethiopia. Ethiop Med J. 2002;40:353–64.PubMed Awole M, Gebre-Selassie S, Kassa T, Kibru G. Isolation of potential bacterial pathogens from the stool of HIV-infected and HIV-non-infected patients and their antimicrobial susceptibility patterns in Jimma hospital, south west Ethiopia. Ethiop Med J. 2002;40:353–64.PubMed
13.
go back to reference Downs JH. The gastrointestinal tract and HIV pathogenesis. SAfr J Clin Nutr. 2010;23:565–8. Downs JH. The gastrointestinal tract and HIV pathogenesis. SAfr J Clin Nutr. 2010;23:565–8.
14.
go back to reference Chhin S, Harwell JI, Bell JD, Rozycki G, Ellman T, Barnett JM, Ward H. Etiology of chronic diarrhea in antiretroviral-naïve patients with HIV infection admitted to Norodom Sihanouk hospital, Phnom Penh, Cambodia. Clin Infect Dis. 2006;43:925–32.CrossRefPubMed Chhin S, Harwell JI, Bell JD, Rozycki G, Ellman T, Barnett JM, Ward H. Etiology of chronic diarrhea in antiretroviral-naïve patients with HIV infection admitted to Norodom Sihanouk hospital, Phnom Penh, Cambodia. Clin Infect Dis. 2006;43:925–32.CrossRefPubMed
15.
go back to reference Brink AK, Mahe C, Watera C, Lugada E, Gilks C, Whitworth J. Diarrhea, CD4 counts and enteric infections in a community-based cohort of HIV-infected adults in Uganda. J Inf Secur. 2002;45:99–106. Brink AK, Mahe C, Watera C, Lugada E, Gilks C, Whitworth J. Diarrhea, CD4 counts and enteric infections in a community-based cohort of HIV-infected adults in Uganda. J Inf Secur. 2002;45:99–106.
17.
go back to reference Suthienkul O, Aiumlaor P, Siripanichgon K, Eampokalap B, Likhanonsakul S, Utrarachkij F. Bacterial causes of AIDS-associated diarrhea in Thailand. South East Asian J Trop Med Public Health. 2001;32:150–70. Suthienkul O, Aiumlaor P, Siripanichgon K, Eampokalap B, Likhanonsakul S, Utrarachkij F. Bacterial causes of AIDS-associated diarrhea in Thailand. South East Asian J Trop Med Public Health. 2001;32:150–70.
18.
go back to reference Obi CL, Bessong PO. Diarrhoeagenic bacterial pathogens in HIV-positive patient with diarrhea in rural communities of Limpopo Province, South Africa. JHPN. 2002;20:230–4.PubMed Obi CL, Bessong PO. Diarrhoeagenic bacterial pathogens in HIV-positive patient with diarrhea in rural communities of Limpopo Province, South Africa. JHPN. 2002;20:230–4.PubMed
19.
go back to reference Rossit ARB, Gottardo de Almeida MT, Nogueira CAM, Oliveira JGC, Barbosa DMU, Moscardini AC. Bacterial, yeast, parasitic, and viral enteropathogens in HIV-infected children from Saõ Paulo state, southeastern Brazil. Diagn Microbiol Infect Dis. 2007;57:59–66.CrossRefPubMed Rossit ARB, Gottardo de Almeida MT, Nogueira CAM, Oliveira JGC, Barbosa DMU, Moscardini AC. Bacterial, yeast, parasitic, and viral enteropathogens in HIV-infected children from Saõ Paulo state, southeastern Brazil. Diagn Microbiol Infect Dis. 2007;57:59–66.CrossRefPubMed
20.
go back to reference Kaur P, Chakraborti A, Asea A. EnteroaggregativeEscherichia coli: an emerging entericfood borne pathogen. Interdiscip Perspect Infect Dis. 2010:1–10. Kaur P, Chakraborti A, Asea A. EnteroaggregativeEscherichia coli: an emerging entericfood borne pathogen. Interdiscip Perspect Infect Dis. 2010:1–10.
21.
go back to reference Gassama- Sow A, Sow PS, Fall F, Camara P, Philippe H, Gukye-N’Diaye a. ordinary and opportunistic enteropathogens associated with diarrhea in Senegalese adults in relation to human immunodeficiency virus serostatus. Int J Infect Dis. 2001;5:192–8.CrossRef Gassama- Sow A, Sow PS, Fall F, Camara P, Philippe H, Gukye-N’Diaye a. ordinary and opportunistic enteropathogens associated with diarrhea in Senegalese adults in relation to human immunodeficiency virus serostatus. Int J Infect Dis. 2001;5:192–8.CrossRef
22.
go back to reference Huang DB, Zhou J. Effect of intensive hand washing in the prevention of diarrheal illness among patients with AIDS: a randomized controlled study. J Med Microbiol. 2007;56:659–63.CrossRefPubMed Huang DB, Zhou J. Effect of intensive hand washing in the prevention of diarrheal illness among patients with AIDS: a randomized controlled study. J Med Microbiol. 2007;56:659–63.CrossRefPubMed
24.
go back to reference Guadalupe M, Sankaran S, George MD, Reay E, Verhoeven D, Shacklett BL. Viral suppression and immune restoration in the gastrointestinal mucosa of human immunodeficiency virus type 1-infected patients initiating therapy during primary or chronic infection. J Virol. 2006;80:8236–47.CrossRefPubMedPubMedCentral Guadalupe M, Sankaran S, George MD, Reay E, Verhoeven D, Shacklett BL. Viral suppression and immune restoration in the gastrointestinal mucosa of human immunodeficiency virus type 1-infected patients initiating therapy during primary or chronic infection. J Virol. 2006;80:8236–47.CrossRefPubMedPubMedCentral
25.
go back to reference DACA: Antimicrobials use, resistance and containment baseline survey syntheses of findings 2013. DACA: Antimicrobials use, resistance and containment baseline survey syntheses of findings 2013.
Metadata
Title
The common enteric bacterial pathogens and their antimicrobial susceptibility pattern among HIV-infected individuals attending the antiretroviral therapy clinic of Hawassa university hospital, southern Ethiopia
Authors
Ayele Kebede
Solomon Aragie
Techalew Shimelis
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Antimicrobial Resistance & Infection Control / Issue 1/2017
Electronic ISSN: 2047-2994
DOI
https://doi.org/10.1186/s13756-017-0288-7

Keynote webinar | Spotlight on menopause

Menopause can have a significant impact on the body, with effects ranging beyond the endocrine and reproductive systems. Learn about the broader systemic effects of menopause, so you can help patients in your clinics through the transition.   

Prof. Martha Hickey
Dr. Claudia Barth
Dr. Samar El Khoudary
Developed by: Springer Medicine
Watch now

Keynote webinar | Spotlight on adolescent vaping

  • Live
  • Webinar | 29-01-2025 | 18:00 (CET)

Growing numbers of young people are using e-cigarettes, despite warnings of respiratory effects and addiction. How can doctors tackle the epidemic, and what health effects should you prepare to manage in your clinics?

Watch it live: Wednesday 29th January, 18:00-19:30 CET
 

Prof. Ann McNeill
Dr. Debbie Robson
Benji Horwell
Developed by: Springer Medicine
Join the webinar

Keynote webinar | Spotlight on modern management of frailty

Frailty has a significant impact on health and wellbeing, especially in older adults. Our experts explain the factors that contribute to the development of frailty and how you can manage the condition and reduce the risk of disability, dependency, and mortality in your patients.

Prof. Alfonso Cruz-Jentoft
Prof. Barbara C. van Munster
Prof. Mirko Petrovic
Developed by: Springer Medicine
Watch now

A quick guide to ECGs

Improve your ECG interpretation skills with this comprehensive, rapid, interactive course. Expert advice provides detailed feedback as you work through 50 ECGs covering the most common cardiac presentations to ensure your practice stays up to date. 

PD Dr. Carsten W. Israel
Developed by: Springer Medizin
Start the cases

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Read more