Skip to main content


Henderson, Heather I.; Napravnik, Sonia; Gower, Emily W.; Aiello, Allison E.; Kinlaw, Alan C.; Williams, Billy; Wohl, David A.; & van Duin, David (Online ahead of print). Resistance in Enterobacterales is Higher among People with HIV. Clinical Infectious Diseases.


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.


Reference Type

Journal Article

Year Published

Online ahead of print

Journal Title

Clinical Infectious Diseases


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

Article Type



United States of America


North Carolina


Aiello - 0000-0001-7029-2537