BACTERIAL INFECTION AND ANTIBIOTIC RESISTANCE IN PATIENTS WITH HUMAN IMMUNODEFICIENCY VIRUS PRESENTING LOWER RESPIRATORY TRACT INFECTION IN NIGERIA

Abstract

ABSTRACTLower Respiratory Tract Infection (LRTI) is associated with mortality and prolonged antibiotics use among HIV/AIDS patients. Sputum samples were collected from 134 HIV/AIDS patients with LRTI and productive cough, visiting University of Abuja Teaching Hospital, Nigeria, to determine the bacterial aetiologies and antibiotic resistance profile. Adequate for culture sputum samples were observed in only 119 subjects (75 females and 44 males) and cultured using standard procedure. Isolates were identified by biochemical method and 16SrRNA gene amplification, purification, sequencing and database nucleotide blast. Antibiotic susceptibility tests were performed and interpreted according to Clinical and Laboratory Standard Institute (CLSI) procedures. Bacteria associated LRTI was found in 20.2% of the patients and Klebsiella pneumonia (29.7%); Enterobacter cloacae (16.7%); Enterobacter hormaechei subsp. xiangfangensis (12.5%); Pseudomonas parafulva; Pseudomonas aeruginosa; Pseudomonas alcaliphila; Klebsiella aerogenes (8.3%); Comamonas testosteroni; Escherichia coli; Acinetobacter junii; Acinetobacter soli and Acinetobacter baumannii were implicated. Isolates show high resistance to amoxicillin-clavulanic acid at 94.1%, trimethoprim-sulfamethoxazole at 75.0% and cefotaxime at 70.0%. The Multiple Antibiotic Resistance (MAR) index of most isolates (62.5%) is within 0.3-0.8 in a range of 0.0 to 0.8. Isolates of the same species were found to have different MAR index in different patients. However, E. cloacae, E. hormaechei subsp. xiangfangensis, A. baumanni and 71.4% of K. pneumonia were Multi-drug Resistant (MDR). Interestingly, Gentamycin, Ciprofloxacin and Imipenem were effective against MDR isolates and showed significant negative correlation with MAR index. We propose that antibiotics with efficacy against MDR isolates could be used to down regulate the selective pressure of other antibiotics, and these MDR pathogens, including those rarely associated with human infection poses potential threat, similar to Methicillin Resistant Staphylococcus aureus (MRSA). Particularly, among the immunocompromised. Furthermore, HIV/AIDS patients present good metrics for profiling the burden and spread of antibiotic resistant bacteria in poor countries.