Prevalence and antimicrobial resistance profiles of respiratory microbial flora in African children with HIV-associated chronic lung disease.
BMC Infect Dis
; 21(1): 216, 2021 Feb 25.
Article
em En
| MEDLINE
| ID: mdl-33632144
ABSTRACT
BACKGROUND:
HIV-associated chronic lung disease (CLD) is common among children living with HIV (CLWH) in sub-Saharan Africa, including those on antiretroviral therapy (ART). However, the pathogenesis of CLD and its possible association with microbial determinants remain poorly understood. We investigated the prevalence, and antibiotic susceptibility of Streptococcus pneumoniae (SP), Staphylococcus aureus (SA), Haemophilus influenzae (HI), and Moraxella catarrhalis (MC) among CLWH (established on ART) who had CLD (CLD+), or not (CLD-) in Zimbabwe and Malawi.METHODS:
Nasopharyngeal swabs (NP) and sputa were collected from CLD+ CLWH (defined as forced-expiratory volume per second z-score < - 1 without reversibility post-bronchodilation with salbutamol), at enrolment as part of a randomised, placebo-controlled trial of azithromycin (BREATHE trial - NCT02426112 ), and from age- and sex-matched CLD- CLWH. Samples were cultured, and antibiotic susceptibility testing was conducted using disk diffusion. Risk factors for bacterial carriage were identified using questionnaires and analysed using multivariate logistic regression.RESULTS:
A total of 410 participants (336 CLD+, 74 CLD-) were enrolled (median age, 15 years [IQR = 13-18]). SP and MC carriage in NP were higher in CLD+ than in CLD- children 46% (154/336) vs. 26% (19/74), p = 0.008; and 14% (49/336) vs. 3% (2/74), p = 0.012, respectively. SP isolates from the NP of CLD+ children were more likely to be non-susceptible to penicillin than those from CLD- children (36% [53/144] vs 11% [2/18], p = 0.036). Methicillin-resistant SA was uncommon [4% (7/195)]. In multivariate analysis, key factors associated with NP bacterial carriage included having CLD (SP adjusted odds ratio (aOR) 2 [95% CI 1.1-3.9]), younger age (SP aOR 3.2 [1.8-5.8]), viral load suppression (SP aOR 0.6 [0.4-1.0], SA 0.5 [0.3-0.9]), stunting (SP aOR 1.6 [1.1-2.6]) and male sex (SA aOR 1.7 [1.0-2.9]). Sputum bacterial carriage was similar in both groups (50%) and was associated with Zimbabwean site (SP aOR 3.1 [1.4-7.3], SA 2.1 [1.1-4.2]), being on ART for a longer period (SP aOR 0.3 [0.1-0.8]), and hot compared to rainy season (SP aOR 2.3 [1.2-4.4]).CONCLUSIONS:
CLD+ CLWH were more likely to be colonised by MC and SP, including penicillin-non-susceptible SP strains, than CLD- CLWH. The role of these bacteria in CLD pathogenesis, including the risk of acute exacerbations, should be further studied.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Infecções por HIV
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Farmacorresistência Bacteriana
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Pneumopatias
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Antibacterianos
Tipo de estudo:
Clinical_trials
/
Etiology_studies
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Prevalence_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adolescent
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Female
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Humans
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Male
País/Região como assunto:
Africa
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article