Prevalence, Antibiotic Susceptibility Pattern, and Associated Factors of Enteric Bacterial Pathogens Among HIV Infected Patients with Diarrhea Attending the ART Clinic of Dilla University Referral Hospital, Southern Ethiopia

Abstract

Background: In people with human immunodeficiency virus infection, diarrhea is reportedly associated with significant morbidity and mortality. Therefore, the aim of this study was to determine the prevalence, antibiotic susceptibility pattern, and associated factors of enteric bacterial pathogens among HIV infected patients with diarrhea attending the antiretroviral treatment (ART) clinic of Dilla University Referral Hospital, southern Ethiopia. Methods: This institutional-based cross-sectional study was conducted on 422 study participants attending at ART clinic of Dilla University Referral Hospital from March to August 2022. Demographic and clinical data were collected by using a semi-structured questionnaire. Stool specimens were inoculated on selective media like Butzller’s medium and Xylose Lysine Deoxycholate (XLD) agar. Antimicrobial resistance pattern was assessed by using Kirby-Bauer disk diffusion techniques. Adjusted odds ratio (AOR) and 95% Confidence Interval (CI) was used to determine the presence of association. Results: A total of 422 adult patients were enrolled in this study, 51.7% were females. The mean age of the study participants was 27.4 (± 15.6 SD) years. The overall prevalence of enteric pathogens was 14.7% (95% CI=11.4– 18.2). Shigella spp was the most prevalent organism. Being a farmer (AOR=5.1; 95% CI=1.4– 19.1; p < 0.015), the habit of hand washing after toilet (AOR=1.9; 95% CI=1.02– 3.47; p < 0.04), low CD 4 cell count of < 200 cells (AOR=2.22; 95% CI=1.15– 4.27; p < 0.02), and longer duration of diarrhea (AOR=2.68; 95% CI=1.23– 5.85; p < 0.01) were statistically associated. In total, 98.4% of enteric bacterial isolates were sensitive for Meropenem, whereas 82.5% were resistant against Ampicillin. Multidrug resistance was detected in 49.2% of enteric bacteria. Conclusion: We found that enteric bacteria are common causative agents of diarrhea in immune-compromised patients. The high rate of drug resistance calls for escalating antimicrobial susceptibility testing before prescribing antimicrobial agent. Keywords: enteric pathogen, human immunodeficiency virus, diarrhea