Characterization Of Uropathogenic Escherichia Coli (Upec) In Hiv Seropositive Women With Asymptomatic Bacteriuria

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2022-08

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University Of Ghana

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BACKGROUND: Asymptomatic bacteriuria (ASB), a precursor for Urinary tract infection (UTI), is high among People living with HIV (PLHIV). E. coli is the most implicated organism. An understanding of the risk factors for ASB, virulence genes and resistance profile of uropathogens among this population is important to the management and control. AIM: To characterize uropathogenic E. coli (UPEC) in HIV seropositive women with asymptomatic bacteriuria METHODOLOGY: This cross-sectional study was carried out at St. Martin de Pores Hospital, Eikwe in the Western Region of Ghana. A structured questionnaire was used to extract clinical information from the folders of 400 HIV seropositive women. The information included patient demographics, history of hospitalization, HAART treatment initiation date and WHO disease stage. Urine samples were obtained, cultured and identified with MALDI TOF biotyper. Antibiotic resistance pattern was determined, and genes coding for virulence and integrons were screened for using Multiplex PCR and gel imaging techniques. RESULTS: From the 400 samples cultured, 21.15% (85/400) were positive. The most prevalent organisms were; Escherichia coli 69.4% (59/85), Enterococcus faecalis 8.2% (7/85), Klebsiella pneumoniae 7.0% (6/85)), Proteus mirabilis 7.0% (6/85), Staphylococcus hemolyticus 3.5% (3/85). All uropathogenic E. coli isolates were resistant to ampicillin and 98.3% (58/59), resistant to trimethoprim sulfamethoxazole, followed by tetracycline 94.9% (56/59), cefuroxime 74.6% (45/59), amoxiclav 49.2% (30/59) and ciprofloxacin 32.2% (19/59). The lowest resistance was recorded to meropenem and fosfomycin at 1.7% and nitrofurantoin 6.8% (4/59). The commonest virulence genes observed were ChuA 66.1% (n=39/59), PapC 57.6% (n=34/59), cnf1 50.8% (n=30/59), kpsMTII 45.8% (n=27/59), iuAt 35.6% (n=21/59) and usp gene 8.5% (n=5/59). Two isolates (3.4%) harbored all 5 genes (iuAt, cnf1, papC, chuA, kpsMTII). Five isolates haboured iuAt, cnf1, papC and chuA (8.5%, n=5/59). Three genes (iuAt, cnf1, papC) were all observed in 6 isolates (10.2%, n=6/59) whilst 7 isolates (12%, n=7/59) were found to harbor genes iuAt and cnf1. The commonest integron was intI 42% (n=25/59) followed by intII 20% (n=12/59). Viral load [(OR=1.000, 95% CI, 1.000-1.000) (p = 0.295)], HAART duration [(OR=1.036, 95% CI, 0.287-1.042) (p=0.287)], age [(OR=1.020, 95% CI, 0.999-1.042) (p = 0.06)] and WHO disease stage [(OR=1.286, 95% CI, 0.535-1.6) (p = 0.885)] showed no significant association with the occurrence of asymptomatic bacteriuria (p≥0.05). HAART duration was observed to be a predictor of resistance to amoxiclav [(OR=1.329, 95% CI, 1.113-1.588) (p= 0.002)]. CONCLUSION: This study showed that asymptomatic bacteriuria is common among women living with HIV (WLHIV) visiting Eikwe district hospital, with no association with age, viral load, WHO disease stage and HAART duration. High prevalence of multidrug resistant UPEC coupled with the high carriage of virulence genes indicates that WLHIV are at a high risk of developing urinary tract infections with the potential for complications. There is a need for regular monitoring of bacteriuria and antibiotic susceptibility testing among this population.

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MPhil. Medical Microbiology

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HIV Seropositive Women, Uropathogenic Escherichia Coli, Asymptomatic Bacteriuria

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