HIV-specific factors contribute to increased risk for MDR-E
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People with HIV are at an increased risk for multidrug-resistant Enterobacterales infection because of HIV-specific factors in addition to already established risk factors, a recent study showed.
“In a prior study we had observed that Enterobacterales isolates obtained from people with HIV had a significantly higher prevalence of multidrug resistance compared with isolates from people without HIV,” Heather I. Henderson, DVM, MPH, researcher at the University of North Carolina at Chapel Hill Gillings School of Global Public Health, told Healio. “We hypothesized that the greater prevalence could be due to both HIV-related factors, such as immunosuppression and associated antibiotic prophylaxis, as well as risk factors for the general population, such as comorbidities and invasive medical procedures. People with HIV (PWH) have an increased burden of comorbidities, and we hypothesized that this contributed to the increase in multidrug resistance.”
Henderson and colleagues performed an observational study of PWH participating in an HIV clinical cohort and engaged in care at a tertiary care center in the southeastern U.S. between 2000 and 2018. According to the study, they evaluated demographic and clinical predictors of multidrug-resistant Enterobacterales (MDR-E) by estimating prevalence ratios (PRs) and employing machine learning classification algorithms.
They also created a predictive model to estimate risk of MDR-E among PWH using a machine learning approach.
Ultimately, MDR-E was isolated from 1.6% (95% CI, 1.2%-2.1%) of the 4,534 study participants. In unadjusted analyses, MDR-E was strongly associated with HIV-specific factors, as well as other established facts, including nadir CD4 cell count of 200 cells/mm3 or less (PR = 4; 95% CI, 2.3-7.4), history of an AIDS-defining clinical condition (PR = 3.7; 95% CI, 2.3-6.2) and hospital admission in the prior 12 months (PR = 5; 95% CI, 3.2-7.9).
After entering all variables in the machine learning algorithms, the most important clinical predictors of MDR-E were hospitalization, history of renal disease, history of an AIDS-defining clinical condition, CD4 cell count nadir of 200 cells/mm3 or less and current CD4 cell count 201 to 500 cells/mm3.
“Our findings underscore the need to minimize the time from HIV infection to linkage to HIV care, as well as the time from HIV care initiation to antiretroviral therapy initiation,” Henderson said. “Preventing low CD4 cell counts, AIDS-defining clinical conditions, and associated hospitalizations will also help to prevent multidrug-resistant Enterobacterales infections in people with HIV.”
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