Intestinal Carriage of Extended-Spectrum Betalactamase Producing Enterobacteria in HivAids Patient

Abstract

Background: Routine empiric antibiotic therapy is common in patients living with HIV/AIDS. Such routine antibiotic regimen could lead to selection of multidrug resistance especially ESBLs in hitherto drug sensitive intestinal colonizing flora. There is paucity of data to describe intestinal carriage of ESBL-producing enterobacteria in HIV/AIDS patients. Aim: This study was designed to examine HIV/AIDS patients for faecal carriage with extendedspectrum beta-lactamase producing enterobacteria at a district care hospital setting in Ghana. Methods: A cross-sectional study design was conducted to recruit HIV/AIDS patients at the Achimota District Hospital in Accra from March through May 2017. Questionnaire-administered interviews were conducted to determine independent risk factors for ESBL faecal carriage. Faecal samples were examined for ESBL-producing enterobacteria by serial dilution colony counts, polymerase chain reaction (PCR) and nucleotide sequencing. Results: Overall, 43 of 100 patients living with HIV/AIDS had faecal carriage with ESBLproducing enterobacteria. The predominant ESBL type was CTX-M, mostly blaCTX-M-15. Among patients colonized with CTX-M-15 positive enterobacteria, these isolates were the predominant faecal enterobacteria. In such patients, the total faecal ESBL-negative enterobacteria were the sub-dominant colonies. Two patients were each colonized by isolates that carried the complex mutant TEM beta-lactamase, blaTEM-121. SHV and OXA type ESBLs were not identified. In a multivariate logistic regression, the number of persons living with an HIV/AIDS patient in a household was an independent risk factor for ESBL faecal colonization. Conclusion. Patients living with HIV/AIDS patients may constitute a significant reservoir of ESBLs in the hospital and community. The results highlight the need for better surveillance of ESBLs in the hospital, and Ghana as a whole.