MDR-E prevalence higher among people with HIV
The relative prevalence of multidrug-resistant Enterobacterales was 38% higher among people with HIV compared with HIV-negative patients, according to the results of a large study published in Clinical Infectious Diseases.
“The study was prompted by the fact that very little information exists in the literature characterizing antimicrobial resistance in gram-negative bacterial infections among people with HIV, although people with HIV could be at increased risk for resistant infections,” Heather I. Henderson, DVM, MPH, a researcher at the University of North Carolina at Chapel Hill Gillings School of Global Public Health, told Healio.
“Potential reasons for increased risk include a greater burden of known risk factors — such as comorbidities — compared with the general population, as well as HIV-specific factors like HIV-related intestinal inflammation,” Henderson said.
Henderson and colleagues analyzed data from 36,521 patients the UNC Health system who had at least one clinical culture with growth of an Enterobacterales species from 2000 to 2018 — 440 of whom were patients with HIV (PWH).
They found that the estimated overall prevalence of MDR-E was higher among PWH (21.5%; 95% CI, 18.2%-25.1%) compared with 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).
Additionally, MDR-E prevalence was 3 to 10 percentage points higher among PWH than among patients without HIV throughout the study period based on the 5-year moving average. PWH also had higher rates of antimicrobial resistance than patients without HIV for all antibiotic classes included in the analysis, including penicillin, penicillin/beta-lactamase inhibitor combinations and sulfonamides.
“For a clinician who suspects a gram-negative bacterial infection in a person with HIV, the overall risk for antimicrobial resistance is higher compared with that in the general population,” Henderson said. “This should be taken into account when selecting an antibiotic and also emphasizes the need for antimicrobial stewardship in people with HIV.”
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