Bacterial profile and antimicrobial resistance of community acquired respiratory tract infection among people living with HIV in a low-resource setting

Abstract

Background
Respiratory tract infections (RTIs) and pneumonia pose significant health concerns for people living with HIV (PLWH). Antimicrobial resistance also represents a challenge to these populations. Hence, the aim of the study was to investigate bacterial profile and antimicrobial resistance in RTIs among PLWH to guide effective treatment strategies.


Methods
The study included 71 newly diagnosis PLWH presented with community acquired RTIs. All participants were subjected to clinical, laboratory and radiological assessments. Sputum specimens were collected using aseptic techniques and underwent a controlled culture process to isolate bacterial pathogens. Identification of the causative agents was achieved through Gram staining, assessment of colony morphology, and targeted biochemical testing. Antibiotic sensitivity was determined using the Kirby-Bauer Disc Diffusion method.


Results
Bronchopneumonia emerged as the leading presentation, affecting 35%. This was followed by Pneumocystis pneumonia (PCP), which was identified in 17%. Mortality among participants admitted to the ward was 17% compared to 56% among intensive care unit (ICU)-admission. Gram-negative bacteria accounted for 59.1%, while Gram-positive organisms represented 40.9%. Klebsiella was the predominant isolate (35%) followed by Streptococcus (25%) and Acinetobacter (13%). Multidrug resistance (MDR) was observed in 59.1% of isolates. Gram-negative organisms demonstrated resistance across nearly all antibiotic classes. Methicillin resistant staph aureus (MRSA) and MR-CoNS exhibited high resistance to multiple agents, while streptococcus spp. showed comparatively lower resistance to some antibiotics.


Conclusions
Community acquired RTIs among PLWH are associated with high frequency of Gram-negative MDR bacteria. These conditions are associated with substantial morbidity and mortality particularly among those admitted to ICU.