Prevalence, Risk Factors and Antimicrobial Resistance of Enterococci caused Urinary Tract Infection among People Living with HIV in Addis Ababa, Ethiopia
Main Article Content
Keywords
Enterococci, Enterococcus faecium, Enterococcus faecalis, Urinary tract Infections, People living with HIV
Abstract
Background: Urinary tract infections (UTIs) are among the most common infections worldwide, affecting millions of people each year. The antimicrobial resistance characteristic of Enterococci worsens complications among this vulnerable population. This study aimed to estimate the prevalence of Enterococci-caused UTIs, their risk factors, and antimicrobial resistance profile among people living with HIV in Addis Ababa, Ethiopia.
Methodology: Hospital-based cross-sectional study was conducted from October 2022 to April 2023. Presumptive Enterococci were identified using standard microbiological culture and biochemical tests and confirmed using Matrix-Assisted Laser Desorption Ionization-Time of Flight of Mass Spectrometry at the species level.
Results: This study revealed that among the (n= 102) people living with HIV-acquired culture-confirmed UTIs with diverse bacterial uropathogens, (n= 20; 19.6%) were acquired UTIs associated with Enterococcus species: E. faecalis 80% and E. faecium 20%. Earning monthly income <3000 Ethiopian birr with (adjusted OR) =3.19; (95% CI: 1.05, 9.66) and having exposure to anti-tuberculosis drugs (Adjusted OR = 13.62; 95%CI: 3.53, 52.63) were positively associated with the occurrence of Enterococci-caused UTI. All Enterococci isolates had multi-drug and extensive drug-resistance strains.
Conclusion: The study concluded a higher prevalence of Enterococci-caused UTIs, with predicting factors: lower income per month, and exposure to antituberculosis drugs, and high level of antimicrobial resistance. Hence, there should be a targeted intervention that could tackle the higher prevalence of infection and antimicrobial resistance among these vulnerable populations, steering the identified predicting factors.
References
2. McLellan LK, Hunstad DA. Urinary Tract Infection: Pathogenesis and Outlook. Trends in molecular medicine. 2016;22:946–57.
3. Lin E, Bhusal Y, Horwitz D, Shelburne SA, Trautner BW. Overtreatment of Enterococcal Bacteriuria. Archives of Internal Medicine. 2012;172:33–8.
4. Fiore E, Van Tyne D, Gilmore MS. Pathogenicity of Enterococci. Microbiology spectrum. 2019;7:GPP3-0053-2018.
5. Álvarez-Artero E, Campo-Nuñez A, García-García I, García-Bravo M, Cores-Calvo O, Galindo-Pérez I, et al. Urinary tract infection caused by Enterococcus spp.: Risk factors and mortality. An observational study. Revista Clínica Española (English Edition). 2021;221:375–83.
6. Agudelo Higuita NI, Huycke MM. Enterococcal Disease, Epidemiology, and Implications for Treatment. 2014 Feb 4. In: Gilmore MS, Clewell DB, Ike Y, Shankar N, editors. Enterococci: From Commensals to Leading Causes of Drug Resistant Infection [Internet]. Boston: Massachusetts Eye and Ear Infirmary; 2014–
7. Olaru ID, Tacconelli E, Yeung S, Ferrand RA, Stabler RA, Hopkins H, et al. The association between antimicrobial resistance and HIV infection: a systematic review and meta-analysis. Clinical microbiology and infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2021;27:846–53.
8. Dropulic LK, Lederman HM. Overview of Infections in the Immunocompromised Host. Microbiology spectrum. 2016;4:10.1128/microbiolspec.dmih2-0026–2016.
9. Skrzat-Klapaczyńska A, Matłosz B, Bednarska A, Paciorek M, Firląg-Burkacka E, Horban A, et al. Factors associated with urinary tract infections among HIV-1 infected patients. PLoS ONE. 2018;13:1–10.
10. Codelia-Anjum A, Lerner LB, Elterman D, Zorn KC, Bhojani N, Chughtai B. Enterococcal Urinary Tract Infections: A Review of the Pathogenicity, Epidemiology, and Treatment. Antibiotics. 2023;12:778.
11. Gilmore MS, Clewell DB, Ike Y, Shankar N, editors. Enterococci: From Commensals to Leading Causes of Drug Resistant Infection [Internet]. Boston: Massachusetts Eye and Ear Infirmary; 2014–. PMID: 24649510.
12. Boccella M, Santella B, Pagliano P, De Filippis A, Casolaro V, Galdiero M, et al. Prevalence and Antimicrobial Resistance of Enterococcus Species: A Retrospective Cohort Study in Italy. Antibiotics (Basel, Switzerland). 2021;10:1552.
13. Bhardwaj SB. Enterococci: An Important Nosocomial Pathogen. In: Kırmusaoğlu S, Bhardwaj SB, editors. Pathogenic Bacteria. Rijeka: IntechOpen; 2019. Retrieved from https://www.intechopen.com/chapters/70494. Accessed on July, 2024.
14. O’Driscoll T, Crank CW. Vancomycin-resistant enterococcal infections: epidemiology, clinical manifestations, and optimal management. Infection and drug resistance. 2015;8:217–30.
15. Ali S, Mirza I, Yaqoob S, Hussain A, Khan I, Rafiq Y. Antimicrobial susceptibility pattern of enteroccoccus species isolated from patients of urinary tract infection. Gomal Journal Of Medical Sciences. 2014;12:11–4.
16. Guzman Prieto AM, van Schaik W, Rogers MRC, Coque TM, Baquero F, Corander J, et al. Global emergence and dissemination of enterococci as nosocomial pathogens: Attack of the clones? Frontiers in Microbiology. 2016;7:1–15.
17. Ngowi BN, Sunguya B, Herman A, Chacha A, Maro E, Rugarabamu LF, et al. Prevalence of Multidrug Resistant UTI Among People Living with HIV in Northern Tanzania. Infection and Drug Resistance. 2021;14:1623–33.
18. Tilahun M, Fiseha M, Alebachew M, Gedefie A, Ebrahim E, Tesfaye M, et al. Uro-pathogens: Multidrug resistance and associated factors of community-acquired UTI among HIV patients attending antiretroviral therapy in Dessie Comprehensive Specialized Hospital, Northeast Ethiopia. PloS one. 2024;19:e0296480.
19. Tilahun M, Gedefie A, Sahle Z. Asymptomatic Carriage Rate, Multidrug Resistance Level, and Associated Risk Factors of Enterococcus in Clinical Samples among HIV-Positive Patients Attending at Debre Birhan Comprehensive Specialized Hospital, North Showa, Ethiopia. BioMed research international. 2023;2023:7310856.
20. Fenta GM, Legesse MH, Weldearegay GM. Bacteriuria and their Antibiotic Susceptibility Patterns among People Living with HIV Attending Tikur Anbessa Specialized and Zewditu Memorial Hospital ART Clinics, Addis Ababa, Ethiopia. Journal of Bacteriology & Parasitology. 2016;07.
21. Marami D, Balakrishnan S, Seyoum B. Prevalence, Antimicrobial Susceptibility Pattern of Bacterial Isolates, and Associated Factors of Urinary Tract Infections among HIV-Positive Patients at Hiwot Fana Specialized University Hospital, Eastern Ethiopia. Can J Infect Dis Med Microbiol. 2019 Feb 6;2019:6780354. doi: 10.1155/2019/6780354.
22. Gebremedhin KB, Yisma E, Alemayehu H, Medhin G, Belay G, Bopegamage S, et al. Urinary tract infection among people living with human immunodeficiency virus attending selected hospitals in Addis Ababa and Adama, central Ethiopia. Frontiers in Public Health. 2024;12:1–12.
23. Mubarak AG, El-Zamkan MA, Younis W, Saleh SO, Abd-Elhafeez HH, Yoseef AG. Phenotypic and genotypic characterization of Enterococcus faecalis and Enterococcus faecium isolated from fish, vegetables, and humans. Scientific Reports. 2024;14:1–17.
24. Nakamura T, Ishikawa K, Matsuo T, Kawai F, Uehara Y, Mori N. Enterococcus hirae bacteremia associated with acute pyelonephritis in a patient with alcoholic cirrhosis: a case report and literature review. BMC Infectious Diseases. 2021;21:999.
25. The of Encyclopedia of Britannica. “Addis Ababa”. Encyclopedia Britannica. Retrieved from https://www.britannica.com/place/Addis-Ababa. Accessed on July, 2024.
26. World Population Review. Ethiopia Population 2024 (Live). Retrieved from https://worldpopulationreview.com/countries/ethiopia-population. Accessed on July, 2024.
27. Tessema NN, Ali MM, Zenebe MH. Bacterial associated urinary tract infection, risk factors, and drug susceptibility profile among adult people living with HIV at Haswassa University Comprehensive Specialized Hospital, Hawassa, Southern Esthiopia. Scientific Reports. 2020;10:10790.
28. Hantalo A, Haile K, Bisetegen F, Woldeamanuel Y, Haile Hantalo A, Haile Taassaw K, et al. Isolation and Antibiotic Susceptibility Pattern of Bacterial Uropathogens and Associated Factors Among Adult People Living with HIV/AIDS Attending the HIV Center at Wolaita Sodo University Teaching Referral Hospital, South Ethiopia. HIV/AIDS (Auckland, NZ). 2020;12:799–808.
29. McNulty C A, Jones L. Diagnosis of urinary tract infections Quick reference tool for primary care for consultation and local adaptation About Public Health England. PHE publications. 2020. Available from https://assets.publishing.service.gov.uk/media/5f89809ae90e072e18c0ccc2/UTI_diagnostic_flowchart_NICE-October_2020-FINAL.pdf. Accessed on July, 2024.
30. Chen YC, Chang CC, Chiu THT, Lin MN LC. The risk of urinary tract infection in vegetarians and non-vegetarians: a prospective study. Scientific Reports. 2020;10:906.
31. Collins and Lyne’s. Microbiological Methods Collins and Lyne’s Eighth Edition. retreieved from https://mmstcchemistry.weebly.com/. Retreieved from https://mmstcchemistry.weebly.com/. Accessed on July, 2024.
32. National Institutes of Health. Iron Fact Sheet for Consumers Iron. US Department of Health & Human Services. Retrieved from https://ods.od.nih.gov/factsheets/Iron-Consumer/. Accessed on July, 2024.
33. De Bruyne K, Slabbinck B, Waegeman W, Vauterin P, De Baets B, Vandamme P. Bacterial species identification from MALDI-TOF mass spectra through data analysis and machine learning. Systematic and Applied Microbiology. 2011;34:20-29.
34. CLSI. Catalogue_2019 -The Highest Standards for Global Health Care. Retrieved from https://clsi.org/media/3266/catalog2019_web.pdf. Accessed on August, 2024.
35. CLSI. M45_2016: Methods for Antimicrobial Dilution and Disk Susceptibility Testing of Infrequently Isolated or Fastidious Bacteria. Retrieved from https://clsi.org/shop/standards/m45/. Accessed on August, 2024.
36. Rafailidis PI, Kofteridis D. Proposed amendments regarding the definitions of multidrug-resistant and extensively drug-resistant bacteria. Expert review of anti-infective therapy. 2022;20:139-146.
37. Maddukuri G, Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clinical Microbiology and Infection. 2012;18:268–81.
38. Afunwa RA, Ezeanyinka J, Afunwa EC, Udeh AS, Oli AN, Unachukwu M. Multiple Antibiotic Resistant Index of Gram-Negative Bacteria from Bird Droppings in Two Commercial Poultries in Enugu, Nigeria. Open Journal of Medical Microbiology. 2020;10:171-18.
39. Akinbami A, Bode-Shojobi I, Ajibola S, Oshinaike O, Adediran A, Ojelabi O, et al. Prevalence of Asymptomatic Bacteriuria in HIV Infected Patients in a Tertiary Hospital in Lagos, Nigeria. World Journal of AIDS. 2013;03:105–10.
40. M.L DKY, Samreen DS. Asymptomatic urinary tract infection with multidrug resistant pathogens in retro positive patients on ART. International Journal of Medical Research and Review. 2017;5:610–5.
41. Murugesh K, Deepa S, Ravindranath C, Venkatesha D. Multidrug resistant uropathogens in HIV: Are they a threat to community? International Journal of Scientific Study. 2014;2:38–42.
42. Nwadioha SI, Nwokedi EOP, Ikeh I, Egesie J, Kashibu E. Antibiotic susceptibility pattern of uropathogenic bacterial isolates from Aids patients in a Nigerian tertiary hospital. 2010;1 December:530–4.
43. Goel V, Kumar D, Kumar R, Mathur P, Singh S. Community Acquired Enterococcal Urinary Tract Infections and Antibiotic Resistance Profile in North India. Journal of laboratory physicians. 2016;8:50–4.
44. World HealthOrganization, Food, of the United Nations AO, for Animal Health WO. Antimicrobial resistance: a manual for developing national action plans. Version 1. World Health Organization; 2016. Available from https://iris.who.int/handle/10665/204470. Accessed on July, 2024.
45. Huycke MM, Sahm DF, Gilmore MS. Multiple-drug resistant enterococci: The nature of the problem and an agenda for the future. Emerging Infectious Diseases. 1998;4:239–49.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This is an open-access journal and articles are distributed under the terms of the Creative Commons Attribution Non-Commercial Share-Alike License 4.0. This licence allows users to download and share, remix, tweak and build upon the article for non-commercial purposes, so long as the original authorship is acknowledged and the new creations are licensed under identical terms.
Tadesse Eguale, Ohio State University Global One Health LLC, Addis Ababa, Ethiopia
Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia