Extended-spectrum β-lactamase and carbapenemase-producing bacteria urinary tract infections in adult HIV-positive outpatients at Embu County Referral Hospital, Kenya

Abstract

Background: Antimicrobial resistance (AMR) poses a significant threat to public health, with the Global Action Plan advocating, among others, for strengthening AMR knowledge and evidence base through surveillance and research and optimizing the use of antimicrobial medicines in human and animal health. However, due to inadequate healthcare infrastructure in many resource-constrained countries, epidemiological data to inform infection prevention interventions and guide antimicrobial policy guidelines in people living with HIV is limited. Here, we assessed the prevalence, antimicrobial resistance, and associated factors of bacterial urinary tract infections among adult HIV-positive outpatients in our study setting. Methods: This was a hospital-based cross-sectional study among adult HIV-positive outpatients at Embu County Referral Hospital, Kenya, from January to February 2023. We consecutively recruited 142 patients presenting with or without UTI symptoms and excluded those aged below 18. Demographic and clinical data were collected using a pretested questionnaire, and midstream-clean-catch urine samples were processed by standard microbiological methods. Results: The overall prevalence of UTI was 9.9% (95% confidence interval (CI): 4.96–14.76% (14/142), with 6.3% symptomatic [95% CI: 2.33–10.35% (9/142)], 3.5% asymptomatic [95% CI: 0.49–6.55% (5/142)], and 4.2% recurrent [95% CI: 0.92–7.53% (6/142)] UTIs. Klebsiella pneumoniae was predominant overall (57.1%, 8/14), and in asymptomatic (80%, 4/5) and recurrent (66.7%, 4/6) UTIs. All the isolates were multidrug-resistant, with 36% (5/14) as meropenem-resistant and 14.3% (2/14) of carbapenem-resistant K. pneumoniae were colistin-resistant. E. coli isolates were susceptible to meropenem, amikacin, ciprofloxacin, and levofloxacin. The lowest resistance in K. pneumoniae was in amikacin (12.5%) and colistin (25%). Notably, 79% (11/14) and 35.7% (4/14) of the isolates were extended-spectrum β-lactamase (ESBL) and carbapenemase producers, respectively. Those with recurrent UTI were at higher odds of having UTI [adjusted odds ratio: 7.37, 95% CI: 1.93—28.07 (p = 0.003)]. Conclusions: Our findings highlight a high prevalence of bacterial urinary tract infections, including recurrent ones caused by ESBL-, carbapenemase-producing, and colistin-resistant bacteria among HIV-infected adults. A comprehensive One Health approach is urgently required to reduce the burden of AMR among HIV-infected people through promoting responsible antibiotic use via the existing regulatory frameworks and knowledge transfer, as well as AMR uninterrupted surveillance.