Abstract:
Background: Bacterial pneumonia is a leading cause of morbidity and mortality in HIV-positive
patients worldwide, particularly in Sub-Saharan Africa. Furthermore, antimicrobial resistance is
higher in bacteria isolated from HIV patients with bacterial pneumonia. However, in Ethiopia,
particularly in the study area, research in this regard is scanty.
Objective: This study aimed to determine the bacterial profile, antimicrobial susceptibility
pattern, and associated factors among typical pneumonia-suspected HIV-positive patients in
AMGH, and DFPH, southern Ethiopia, 2022.
Methods: An institution-based cross-sectional study was conducted from 1st March to 30th
September 2022. Pretested semi-structured questionnaire was used to collect demographic,
clinical, and behavioral data. Sputum samples were processed from 386 HIV-positive patients
who were suspected of typical bacterial pneumonia. Sheep blood agar, mannitol salt agar,
chocolate agar, and MacConkey agar were used to isolate bacteria. Pyogenic bacteria were
identified using standard bacteriological techniques, and antimicrobial susceptibility testing was
done by Kirby Bauer’s disk diffusion method on Mueller-Hinton agar. Extended-spectrum β
lactamase (ESβL) and carbapenemase production were confirmed by double disk synergy test
and modified Carbapenem inactivation method, respectively. Data were analyzed using
Statistical Package for Social Sciences (SPSS) version 25. P values <0.05 was considered
statistically significant.
Results: Overall, 39.1% (151/386), 95% CI: 32.4-44) of sputum samples were culture positive.
A total of 152 pyogenic bacterial isolates were identified, with 73% (111/152) Gram-negative
and 27% (41/152) Gram-positive bacteria. The most common isolates were Klebsiella
pneumoniae (25.7% (39/152), Staphylococcus aureus (17.8% (27/152), and Escherichia coli
(15.1%, 23/152). In addition, 60, 53.3, and 59.9% of isolates were resistant to penicillin,
cotrimoxazole, and tetracycline, respectively. 40.7% (11/27) of S.aureus was MRSA. Overall, 88
(57.9%) isolates were multiple drug resistant. About 26.6 (29/109) and 21.1% (23/109) of Gram
negative bacterial isolates were ESBL and carbapenemase producers, respectively. Alcohol
consumption (AOR= 2.72, 95% CI: 1.5-4.94, p = 0.001), CD4 count < 350 (AOR= 3.86, 95% CI:
1.85-8.07, p≤0.001), WHO stages III and IV (AOR= 2.27, 95% CI: 2.6-9.36, p=0.047),
interruption of cotrimoxazole prophylaxis (AOR= 4.22, 95% CI: 2.25-7.89, p≤0.001), and recent
viral load ≥ 150 (AOR= 5.46, 95% CI: 1.86-16.04, p=0.002) were statistically significant.
Conclusion and recommendation: High rates of MDR, MRSA, ESBL and CRE indicate that
bacterial pneumonia is a vexing problem among HIV patients in the study area. In order to
properly diagnose and treat typical pneumonia, we strongly suggest routinely conducting a
culture and antibiotic susceptibility test.
