背景:尿路感染,一种流行的全球传染病,临床问题在HIV阳性个体中没有得到很好的研究。尿路感染已经成为一个全球性的耐药问题,但是TigrayHIV患者中引起UTI的细菌的患病率和抗生素敏感性模式,埃塞俄比亚,知之甚少。这项研究旨在确定UTI引起的细菌的患病率,他们的抗生素敏感性模式,以及在提格雷的Mekelle总医院和Ayder综合专科医院就诊ART诊所的HIV患者的相关危险因素,埃塞俄比亚北部。
方法:从在Mekelle总医院和Ayder综合专科医院的ART诊所就诊的HIV患者中收集清洁捕获中游尿液样本(10-15mL)。基于使用半胱氨酸-乳糖电解质缺陷(CLED)琼脂的标准微生物方案分析样品。通过继代培养到Mac-Conkey中获得细菌分离株的纯菌落,甘露醇盐琼脂和血琼脂平板。然后使用宏观,微观,生物化学,和革兰氏染色方法。使用生化试验如三糖铁琼脂鉴定革兰氏阴性菌,西蒙的柠檬酸琼脂,赖氨酸铁琼脂,尿素,运动性试验,和吲哚测试,而革兰氏阳性分离株是使用过氧化氢酶和凝固酶试验鉴定的。使用Kirby-Bauer圆盘扩散技术分析细菌分离株的抗菌敏感性模式。使用SPSS版本25.0分析数据。
结果:在224例患者中,其中28人(12.5%)感染了引起UTI的细菌。大肠杆菌是优势细菌(16(57%)),其次是肺炎克雷伯菌(4(14%)),和金黄色葡萄球菌(3(11%))。在所有细菌分离物中,其中22例(78.6%)出现多药耐药。发现所有革兰氏阳性(100%)和75%的革兰氏阴性细菌分离株对两种或多种药物具有抗性。有UTI病史的患者,与CD4计数<200细胞/mm3,更可能有显著的菌尿。与男性患者相比,女性患者受UTIs致病细菌的影响更大.超过93%的引起UTI的细菌分离株对呋喃妥因敏感,头孢曲松,环丙沙星,和庆大霉素;而它们对氨苄青霉素具有高度抗性(96%),复方新诺明(82%)和四环素(71%)。
结论:大多数细菌分离株对氨苄青霉素具有高度耐药性,复方新诺明,还有四环素.女性患者受引起UTI的细菌影响更大。在HIV患者中,UTI的患病率最高(12.5%)需要特别注意,以便更好地管理和监测。以前的UTI病史和免疫抑制是UTI的预测因子,强调需要采取涉及分子研究的干预措施,以识别耐药细菌基因并促进患者免疫重建。
BACKGROUND: Urinary tract infections, a prevalent global infectious disease, are clinical issues not well studied in HIV-positive individuals.
UTIs have become a global drug resistance issue, but the prevalence and antibiotic susceptibility patterns of UTI-causing bacteria among HIV patients in Tigray, Ethiopia, are poorly understood. This study aims to identify the prevalence of UTI-causing bacteria, their antibiotic susceptibility patterns, and associated risk factors in HIV patients attending ART clinics at Mekelle General Hospital and Ayder Comprehensive Specialized Hospital in Tigray, Northern Ethiopia.
METHODS: Clean-catch midstream urine samples (10-15 mL) were collected from HIV patients who are attending ART clinics at Mekelle General Hospital and Ayder Comprehensive Specialized Hospital. Samples were analyzed based on standard microbiological protocols using cysteine-lactose electrolyte deficient (CLED) agar. Pure colonies of bacterial isolates were obtained by sub-culturing into Mac-Conkey, Manitol Salt agar and blood agar plates. The bacterial isolates were then identified using macroscopic, microscopic, biochemical, and Gram staining methods. Gram-negative bacteria were identified using biochemical tests like triple sugar iron agar, Simon\'s citrate agar, lysine iron agar, urea, motility test, and indol test, whereas Gram-positive isolates were identified using catalase and coagulase tests. The Kirby-Bauer disk diffusion technique was used to analyze the antimicrobial susceptibility pattern of bacterial isolates. Data was analyzed using SPSS version 25.0.
RESULTS: Among the 224 patients, 28 (12.5%) of them had been infected by UTIs-causing bacteria. E. coli was the dominant bacterium (16 (57%)) followed by K. pneumoniae (4 (14%)), and S. aureus (3 (11%)). Of the total bacterial isolates, 22 (78.6%) of them developed multi-drug resistance. All Gram-positive (100%) and 75% of Gram-negative bacterial isolates were found to be resistant to two or more drugs. Patients with a history of UTIs, and with CD4 count < 200 cells/ mm3, were more likely to have significant bacteriuria. Compared to male patients, female patients were more affected by the
UTIs-causing bacteria. More than 93% of the
UTIs-causing bacterial isolates were susceptible to nitrofurantoin, ceftriaxone, ciprofloxacin, and gentamycin; whereas they are highly resistant to ampicillin (96%), cotrimoxazole (82%) and tetracycline (71%).
CONCLUSIONS: Most of the bacterial isolates were highly resistant to ampicillin, cotrimoxazole, and tetracycline. Female patients were more affected by the
UTIs causing bacteria. The highest prevalence (12.5%) of
UTIs in HIV patients needs special attention for better management and monitoring. Previous UTI history and immune suppression are predictors of UTIs, highlighting the need for intervention measures involving molecular studies to identify resistant bacteria genes and promote patient immune reconstitution.