Resistance in Enterobacterales is Higher among People with HIV

Citation

Henderson, Heather I.; Napravnik, Sonia; Gower, Emily W.; Aiello, Allison E.; Kinlaw, Alan C.; Williams, Billy; Wohl, David A.; & van Duin, David (2022). Resistance in Enterobacterales is Higher among People with HIV. Clinical Infectious Diseases, 75(1), 28-34. PMCID: PMC9402620

Abstract

BACKGROUND: Multidrug-resistant Enterobacterales (MDR-E) are important pathogens. People with human immunodeficiency virus (HIV) may be at greater risk for MDR-E infection given relatively high antibiotic exposure and burden of comorbidities.
METHODS: Analyses were conducted using data collected on 36,521 patients in a healthcare system in North Carolina, who had at least 1 clinical culture with growth of an Enterobacterales species from 2000-2018; 440 were people with HIV infection (PWH). We used generalized linear models to estimate prevalence ratios and differences contrasting patients with and without HIV for resistance to individual antibiotic classes, as well as MDR-E. We assessed trends in prevalence over time by calculating the 5-year moving average and fitting restricted cubic spline models.
RESULTS: The overall prevalence of MDR-E was higher among PWH (21.5% [95% CI: 18.2%-25.1%]) versus patients without HIV (16.5% [95% CI: 16.2%-16.9%], with an adjusted prevalence ratio of 1.38 (95% CI: 1.14-1.65). PWH had higher rates of antimicrobial resistance than patients without HIV for all antibiotic classes analyzed, including penicillins, penicillin/beta-lactamase inhibitor combinations, and sulfonamides. MDR-E prevalence was 3 to 10 percentage points higher among PWH than patients without HIV throughout the study period based on the 5-year moving average.
CONCLUSION: In a large clinical study population in the southeastern US from 2000-2018, the prevalence of antibacterial resistance among Enterobacterales was consistently higher among PWH than patients without HIV. These data highlight the importance of identifying and mitigating the factors contributing to antimicrobial resistance in PWH, given the potential clinical consequences of these resistant pathogens.

URL

http://dx.doi.org/10.1093/cid/ciab901

Reference Type

Journal Article

Year Published

2022

Journal Title

Clinical Infectious Diseases

Author(s)

Henderson, Heather I.
Napravnik, Sonia
Gower, Emily W.
Aiello, Allison E.
Kinlaw, Alan C.
Williams, Billy
Wohl, David A.
van Duin, David

Article Type

Regular

PMCID

PMC9402620

Continent/Country

United States of America

State

North Carolina

ORCiD

Aiello - 0000-0001-7029-2537