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BACKGROUND: Urinary tract infections are one of the most common types of bacterial
infections in humans occurring both in the community and the health care settings. Individuals
infected with Immunodeficiency Virus are at increased risk of both asymptomatic and
symptomatic urinary tract infections. People living with Human immunodeficiency Virus are
likely to be more predisposed to urinary tract infection due to the suppression of their immunity
and women in this category tend to get urinary tract infection more often due to the nature of
their anatomy.
OBJECTIVE: The aim of this study was to assess the prevalence, risk factors, and drug
susceptibility pattern of bacteria associated with urinary tract infection among peoples living
with Human Immunodeficiency Virus.
METHOD: A hospital-based cross-sectional study was conducted among 224 individuals living
with Human Immunodeficiency Virus at Hawassa University comprehensive specialized hospital
from September 17 to November 16, 2018. Midstream urine was collected from the study
participants with sterile wide-mouthed urine cups and inoculated on to Blood and MacConkey
agar. Bacterial isolates were characterized by Gram stain and standard biochemical tests and
Kirby-Bauer method were used for antimicrobial susceptibility testing. Socio-demographic and
clinical data were collected by semi-structured questionnaire. Data was entered in to Excel then
exported to SPSS version 20 and analyzed. Bivariate and multivariate regression model analysis
was used to see the association between dependent and independent variables. Odds ratio with
95% CI and a P value < 0.05 were considered as cut off point to measure the strength and
significance of the association.
RESULT: From the total 224 study participants, 23(10.3%) (95% CI: 6.7–14.7) had UTIs. The
distributions of the bacteria were as follows: Escherichia coli 16 (69.6%), Staphylococcus aureus
2(8.7%), Klebsiella pneumoniae 2(8.7%), Enterobacter aerogenes 2 (8.7%) and Pseudomonas
species 1(4.3%). Female study participants were five times more likely to have urinary tract
infection (AOR=5.3, 95% CI: 1.5-19.2). Urinary tract infection prevalence was also high among
study participants with a previous history of urinary tract infection and CD4+ count <200/m Twenty-two (95.7%) of isolated bacteria were susceptible to nitrofurantoin, 21 (91.3%) to
ciprofloxacin, 20 (87%) to each of norfloxacin and gentamycin while 15 (65.2%) were resistant
to tetracycline and 14 (60.9%) to Trimethoprim-sulphamethoxazole. Multi drug resistance
(MDR) acquired non-susceptibility to at least one agent in three or more antimicrobial categories
was seen in 18 (78.3%) of the isolates.
CONCLUSIONS AND RECOMMENDATIONS: Both Gram negative and Gram positive
bacteria were responsible for urinary tract infection among people living with Human
Immunodeficiency Virus. E. coli were the most predominant isolated organisms. In this study,
the chance of acquiring urinary tract infection was higher among females than males. Most of the
bacterial isolates were susceptible to gentamycin, ceftriaxone, ciprofloxacin, norfloxacin, and
nitrofurantoin. Therefore, continuous follow up is mandatory to reduce the consequence of UTI
and drug resistance bacteria in people living with HIV. |
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