Nontyphoidal salmonella bacteremia in antiretroviral therapy-naïve HIV-infected individuals at three public hospitals in eastern Ethiopia: Prevalence, antimicrobial susceptibility patterns, and associated factors

Abstract

Background: Nontyphoidal Salmonella bacteria have emerged as the prominent cause of severe and life-threatening bacteremia in HIV-infected patients. Antimicrobial resistance is another concern that adversely affects the health outcome of the patients. This study investigated the prevalence, antimicrobial susceptibility pattern of the isolates, and associated factors of nontyphoidal Salmonella bacteremia among antiretroviral therapy-naïve HIV-infected adult individuals at three public hospitals in Eastern Ethiopia. Methods: A cross-sectional study was conducted among 170 antiretroviral therapy-naïve HIV-infected adult individuals in three public hospitals in Eastern Ethiopia from June 2017 to June 2018. Data on sociodemographic and associated factors were collected using a pretested structured questionnaire. Blood specimens were examined for nontyphoidal Salmonella using the recommended culture and serological methods. Data were analyzed using the Statistical Package for Social Sciences version 20.0. Bivariate and multivariate logistic regression models were used to identify the predictors of nontyphoidal Salmonella bacteremia. A P-value <0.05 was considered as statistically significant. Results: The prevalence of nontyphoidal Salmonella bacteremia was 10% (95% CI: 5.93–15.54). A lack of hand washing habit before food preparation (adjusted odds ratio [AOR]: 13.1, 95% CI: 10.40–15.30) and a CD4+ count <200 cells/μL (AOR: 3.61, 95% CI: 1.74–5.25) were found to be significantly associated with nontyphoidal Salmonella bacteremia. Most isolates were sensitive to gentamycin (76.5%), ciprofloxacin (70.5%), and ceftriaxone (58.8%), but resistant to tetracycline (88.2%), chloramphenicol (76.5%), ampicillin (70.6%), and sulfamethoxazole– trimethoprim (70.6%). Conclusion: The prevalence of nontyphoidal Salmonella bacteremia was high. HIV-infected patients who did not wash their hands before food preparation and those whose CD4+ count was <200 cells/μL had significantly higher odds of nontyphoidal Salmonella bacteremia. Tetracycline, chloramphenicol, ampicillin, and sulfamethoxazole–trimethoprim should not be used for the treatment of nontyphoidal Salmonella bacteremia. The treatment needs to be supported by culture isolation and antimicrobial susceptibility tests.