Multidrug-Resistant Bacteria with ESBL Genes: A Growing Threat Among HIV Patients in Nepal

Abstract Background Bacterial opportunistic infections are quite common in HIV patients. Besides HIV-TB coinfection, lower respiratory tract infections by multidrug-resistant bacteria cause significant morbidity and mortality among HIV patients. This study was done to evaluate the bacterial coinfection of LRT and detect plasmid-mediated bla TEM and bla CTX−M genes among Extended-Spectrum β-Lactamase (ESBL) producing isolates from sputum samples in HIV patients. Methods A total of 263 sputum samples from HIV-positive cases were processed with standard microbiological methods to isolate and identify the possible pathogens. The identified bacterial isolates were assessed for antibiotic susceptibility pattern by using modified Kirby Bauer disk diffusion method following Clinical Laboratory Standard Institute (CLSI) guidelines. Plasmid DNA was extracted from multidrug-resistant and ESBL producers for screening of ESBL genes; bla CTX−M and bla TEM by conventional PCR method using specific primers. Results Of 263 sputum samples, 67 (25.48%) were culture positive showing Klebsiella pneumoniae; 17(25.37%) as the most predominant one. A higher rate of infection (4/8, 50%) was observed among old-aged people of 61 -70 years, whereas no infection was observed below 20 years. About 30.0% (15/50) of smokers, 32.86% (23/70) cases with previous pulmonary tuberculosis and 52.38% (11/21) with CD4 count <200 cells/µl were found to be susceptible to LRTIs. Among 53 bacterial isolates, 52.83% (n=28) were multidrug-resistant and 43.4% (n=23) were ESBL producers. All ESBL producers were sensitive to Colistin and Polymyxin B. Of 23 ESBL producers, 47.83% (11/23) and 8.6% (2/23) possessed only bla CTX−M and bla TEM genes respectively and 43.48% (10/23) possessed both ESBL genes. Conclusion The increasing rate of MDR bacterial infections mainly ESBL producers of LRTIs causes difficulty in the management of diseases leading to high morbidity and mortality of HIV patients.