A THESIS SUBMITTED TO THE DEPARTMENT OF MEDICAL LABORATORY SCIENCE, COLLEGE OF MEDICINE AND HEALTH SCIENCES, ARBA MINCH UNIVERSITY, IN PARTIAL FULFILLMENT OF THE REQUIREMENTS OF THE DEGREE OF MASTERS SCIENCE IN MEDICAL MICROBIOLOGY

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.