Prevalence of asymptomatic significant bacteriuria and antibiotic susceptibility pattern of bacterial isolates in HIV-infected patients in Ilorin, Nigeria

Abstract

Background: Urinary tract infection (UTI) is one of the most common type of infections worldwide, and this is usually preceded by  asymptomatic significant bacteriuria (ASB). The emergence of antibiotic resistance in bacteria responsible for UTI makes this entity of  public challenge, which has been fueled by human immunodeficiency virus (HIV) infection. This study determined the prevalence of ASB  and antimicrobial susceptibility pattern of bacteria isolated from urine samples of selected HIV-infected patients in Ilorin, Nigeria.

Methodology: A cross-sectional study of 300 randomly selected HIV-positive patients from Sobi Specialist and Civil Service hospitals in  Ilorin, Kwara State, Nigeria, was conducted from January to March 2019. Clean-catch midstream urine samples were aseptically collected  from each selected participant, cultured on CLED and Blood agar plates, and incubated aerobically at 37oC for 24 hours. The bacterial  growth on the culture plates were identified using standard microbiological techniques. The Kirby-Bauer disk diffusion method was used  to determine the antibiotic sensitivity of the bacterial isolates against a panel of antibiotics.

Results: The overall prevalence of ASB among the participants was 22.3%. Staphylococcus aureus (41.8%, 28/67), Escherichia coli (25.4%,  17/67), and Klebsiella pneumoniae (17.9%, 12/67) were the predominant bacterial isolates. Staphylococcus aureus was resistant to  amoxicillin-clavulanate (64.3%), ceftriaxone (53.6%), ciprofloxacin (64.3%), and nalidixic acid (71.4%); E. coli was also resistant to  amoxicillin-clavulanate (70.6%), ceftriaxone (53.6%), ciprofloxacin (52.9%) and nalidixic acid (64.7%); and K. pneumoniae was moderately  resistant to amoxicillinclavulanate (50.0%) and resistant to ciprofloxacin (58.3%) and nalidixic acid (75.0%). Multidrug resistance (MDR) was observed in 40.8% of the isolates.

Conclusion: The isolation rate of high MDR bacteria highlights the growing challenge of ASB and  UTIs that are becoming increasingly difficult to treat with available antibiotics. Health professionals should be aware of regional resistance pattern to consider in the current empirical antimicrobial therapy for ASB and UTIs among HIV-infected patients. Strategies to  mitigate spread of resistance are urgently needed in the study area.