Microbial Isolates and Antimicrobial Resistance Patterns in Adults with Inborn Errors of Immunity: A Comprehensive Analysis of Sputum Cultures

Abstract

Abstract Purpose Individuals with inborn errors of immunity (IEI) are prone to infections, especially in the respiratory tract. They frequently receive prolonged broad-spectrum antibiotics to treat infections, which can lead to antibiotic resistance. We aimed to identify respiratory pathogens and their antibiotic sensitivity patterns. Methods We collected clinical and demographic data from adult IEI patients. We included patients with available positive sputum cultures between 2014 and 2023. Data from electronic health records covered hospitalizations, respiratory infections (especially pneumonia), yearly antibiotic prescriptions, past sputum cultures, and antibiotic sensitivities. Results We analyzed 314 positive sputum cultures from 36 IEI patients. Patients had a median age of 23.5 years (range: 21-29.5), with 61% being male. The most common bacterial isolates were Haemophilus influenzae (159 isolates), Pseudomonas aeruginosa (51 isolates), and Streptococcus pneumonia (29 isolates). We recorded 992 symptomatic exacerbations (averaging 3.04 per patient per month) necessitating antibiotic treatment, along with 43 pneumonia-related hospitalizations. Haemophilus influenzae showed high resistance rates to cefuroxime (82%), amoxicillin/clavulanic acid (66%), trimethoprim/sulfamethoxazole (59%), and ampicillin/sulbactam (49%). Pseudomonas aeruginosa displayed significant resistance to ciprofloxacin (85%), ceftazidime (42%), and aminoglycosides (23–33%). All Streptococcus pneumonia isolates were tetracycline-resistant, and high resistance rates were observed for penicillin (95.6%), clindamycin (92.3%), and erythromycin (89.6%). It's essential to highlight the substantial resistance of common pathogens to oral antibiotics like ciprofloxacin, tetracycline, cefuroxime, clindamycin, and erythromycin. Conclusion Antimicrobial resistance is a growing concern among vulnerable IEI patients. We suggest conducting similar investigations in other regions to address this issue. The findings should inform future infection management guidelines for IEIs.