Bacterial etiology and antibiotic resistance pattern of septicemia in HIV and non-HIV patients admitted to tertiary care hospitals, Shiraz, South of Iran

F. Ghassabi; T. Hashempour; M. Moghadami; M. A. Davarpanah; M. Kalani; N. Chatrabnous; M. Halaji; H. R. Shahraki; N. Hadi

doi:10.14715/cmb/2017.63.9.20

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Vol. 63 No. 9: Issue 9

Issue Published : September 30, 2017

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Bacterial etiology and antibiotic resistance pattern of septicemia in HIV and non-HIV patients admitted to tertiary care hospitals, Shiraz, South of Iran

https://doi.org/10.14715/cmb/2017.63.9.20

F. Ghassabi

Clinical Microbiology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

T. Hashempour

Clinical Microbiology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

M. Moghadami

Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

M. A. Davarpanah

Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

M. Kalani

Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

N. Chatrabnous

Department of Immunology, Medical School, Kerman University of Medical Sciences, Kerman, Iran

M. Halaji

Clinical Microbiology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

H. R. Shahraki

Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

N. Hadi

Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

Corresponding Author(s) : N. Hadi

nahalhadi.nh@gmail.com

Cellular and Molecular Biology, Vol. 63 No. 9: Issue 9
Article Published : September 30, 2017

Abstract

The present study aimed to determine the bacteriological etiology and antibiotic susceptibility pattern of sepsis in HIV infected and HIV uninfected patients, and related risk factors to introduce an appropriate therapy. This cross-sectional study was conducted from January 2014 to January of 2015 enrolling patients with sepsis associated with or without HIV infection admitted to Shiraz teaching hospitals, South of Iran. Blood and urine cultures were performed and standard microbiological methods were followed for isolation and identification of the bacteria. HIV antibody testing and CD4+ lymphocyte count were done for HIV-infected patients. Antimicrobial susceptibility tests were performed using the disk diffusion method in accordance with CLSI recommendations. Totally, 140 patients with sepsis including 30 HIV-positive, and 110 HIV-negative were enrolled. Our finding showed 26.7% and 20% blood and urine culture positivity in HIV-positive and 20.9% and 14.5% positivity in HIV-negative patients. Staphylococcus aureus, Salmonella spp. and coagulase-negative staphylococci (CoNS) each with frequency of 25% were detected as the most prevalent isolates in samples of HIV patients. In contrast, the main etiology for sepsis in HIV-negative patients was CoNS (47.8%), followed by Escherichia coli (17.4%). The median of CD4+ lymphocyte count and viral load in HIV patients were estimated 10.15 cells/mm3 and 68019.48 copies/mL, respectively. The results of the present study revealed that the main cause of sepsis in the studied hospitals was nosocomial pathogens. These findings highlighted the importance of infection control policies for preventing the emergence and spread of nosocomial infections.

Keywords

Septicemia HIV/AIDS Antimicrobial susceptibility Iran.

Ghassabi, F., Hashempour, T., Moghadami, M., Davarpanah, M. A., Kalani, M., Chatrabnous, N., Halaji, M., Shahraki, H. R., & Hadi, N. (2017). Bacterial etiology and antibiotic resistance pattern of septicemia in HIV and non-HIV patients admitted to tertiary care hospitals, Shiraz, South of Iran. Cellular and Molecular Biology, 63(9), 115–121. https://doi.org/10.14715/cmb/2017.63.9.20

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References

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Baharoon S, Telmesani A, Tamim H, Alsafi E, Aljohani S, Mahmoud E, et al. Community- versus nosocomial-acquired severe sepsis and septic shock in patients admitted to a tertiary intensive care in Saudi Arabia, etiology and outcome. J Infect Public Health. 2015;8:418-24.
Zadeh AO, SeyedAlinaghi S, Hassanzad FF, Hajizadeh M, Mohamadi S, Emamzadeh-Fard S, et al. Prevalence of HIV infection and the correlates among homeless in Tehran, Iran. Asian Pac J Trop Biomed. 2014;4:65-8.
Silva JM, Jr., dos Santos Sde S. Sepsis in AIDS patients: clinical, etiological and inflammatory characteristics. J Int AIDS Soc. 2013;16:17344.
Moreira J, Amancio R, Coelho L, Andrade H, Japiassú A. Interactions between HIV Infection and Sepsis among Critically Ill Patients: A Systematic Review. Clin Res HIV/AIDS. 2015;2:1021.
Adeyemi AI, Sulaiman AA, Solomon BB, Chinedu OA, Victor IA. Bacterial bloodstream infections in HIV-infected adults attending a Lagos teaching hospital. J Health Popul Nutr. 2010;28:318-26.
Varma JK, McCarthy KD, Tasaneeyapan T, Monkongdee P, Kimerling ME, Buntheoun E, et al. Bloodstream infections among HIV-infected outpatients, Southeast Asia. Emerg Infect Dis. 2010;16:1569-75.
Wayne P. Performance Standards for Antimicrobial Susceptibility Testing. Clinical and Laboratory Standards Institute (CLSI) 2015;25th Informational Supplement.
Martin GS. Sepsis, severe sepsis and septic shock: changes in incidence, pathogens and outcomes. Expert Rev Anti Infect Ther. 2012;10:701-6.
Amancio RT, Japiassu AM, Gomes RN, Mesquita EC, Assis EF, Medeiros DM, et al. The innate immune response in HIV/AIDS septic shock patients: a comparative study. PLoS One. 2013;8.
Shehab El-Din EM, El-Sokkary MM, Bassiouny MR, Hassan R. Epidemiology of Neonatal Sepsis and Implicated Pathogens: A Study from Egypt. Biomed Res Int. 2015;509484:4.
Japiassu AM, Amancio RT, Mesquita EC, Medeiros DM, Bernal HB, Nunes EP, et al. Sepsis is a major determinant of outcome in critically ill HIV/AIDS patients. Crit Care. 2010;14:10.
Croda J, Croda MG, Neves A, De Sousa dos Santos S. Benefit of antiretroviral therapy on survival of human immunodeficiency virus-infected patients admitted to an intensive care unit. Crit Care Med. 2009;37:1605-11.
Afessa B, Green B. Clinical course, prognostic factors, and outcome prediction for HIV patients in the ICU. The PIP (Pulmonary complications, ICU support, and prognostic factors in hospitalized patients with HIV) study. Chest. 2000;118:138-45.
Huang L, Quartin A, Jones D, Havlir DV. Intensive care of patients with HIV infection. New England Journal of Medicine. 2006;355:173-81.
Casalino E, Wolff M, Ravaud P, Choquet C, Bruneel F, Regnier B. Impact of HAART advent on admission patterns and survival in HIV-infected patients admitted to an intensive care unit. Aids. 2004;18:1429-33.
Povoa P, Salluh JI. Biomarker-guided antibiotic therapy in adult critically ill patients: a critical review. Ann Intensive Care. 2012;2:2110-5820.
Phe T, Vlieghe E, Reid T, Harries AD, Lim K, Thai S, et al. Does HIV status affect the aetiology, bacterial resistance patterns and recommended empiric antibiotic treatment in adult patients with bloodstream infection in Cambodia? Trop Med Int Health. 2013;18:485-94.
Nadjm B, Mtove G, Amos B, Walker NF, Diefendal H, Reyburn H, et al. Severe febrile illness in adult hospital admissions in Tanzania: a prospective study in an area of high malaria transmission. Trans R Soc Trop Med Hyg. 2012;106:688-95.
Mayanja BN, Todd J, Hughes P, Van der Paal L, Mugisha JO, Atuhumuza E, et al. Septicaemia in a population-based HIV clinical cohort in rural Uganda, 1996-2007: incidence, aetiology, antimicrobial drug resistance and impact of antiretroviral therapy. Trop Med Int Health. 2010;15:697-705.
Peters RP, Zijlstra EE, Schijffelen MJ, Walsh AL, Joaki G, Kumwenda JJ, et al. A prospective study of bloodstream infections as cause of fever in Malawi: clinical predictors and implications for management. Trop Med Int Health. 2004;9:928-34.
Grozdanovski K, Milenkovic Z, Demiri I, Spasovska K. Prediction of outcome from community-acquired severe sepsis and septic shock in tertiary-care university hospital in a developing country. Crit Care Res Pract. 2012;182324:17.
Muyanja SZ, Larke N, Rutebarika D, Kaddu I, Nakubulwa S, Levin J, et al. Decreasing trends of bacteraemia among HIV-infected Ugandan adults: incidence, aetiology, clinical outcomes and effect of antiretroviral therapy in a semi-urban setting (2000-2008). Trop Med Int Health. 2011;16:756-65.
Greenberg JA, Lennox JL, Martin GS. Outcomes for critically ill patients with HIV and severe sepsis in the era of highly active antiretroviral therapy. J Crit Care. 2012;27:51-7.
Novosad SA, Sapiano MR, Grigg C, Lake J, Robyn M, Dumyati G, et al. Vital Signs: Epidemiology of Sepsis: Prevalence of Health Care Factors and Opportunities for Prevention. MMWR Morb Mortal Wkly Rep. 2016;65:864-9.
Barati M, Taher MT, Abasi R, Zadeh MM, Barati M, Shamshiri AR. Bacteriological profile and antimicrobial. Archives of Clinical Infectious Diseases. 2009;4:87-95.
Sedigh Ebrahim-Saraie H, Motamedifar M, Mansury D, Halaji M, Hashemizadeh Z, Ali-Mohammadi Y. Bacterial Etiology and Antibacterial Susceptibility Patterns of Pediatric Bloodstream Infections: A Two Year Study From Nemazee Hospital, Shiraz, Iran. J Compr Ped. 2016;7:e29929.
Farajnia S, Alikhani MY, Ghotaslou R, Naghili B, Nakhlband A. Causative agents and antimicrobial susceptibilities of urinary tract infections in the northwest of Iran. Int J Infect Dis. 2009;13:140-4.
Derese B, Kedir H, Teklemariam Z, Weldegebreal F, Balakrishnan S. Bacterial profile of urinary tract infection and antimicrobial susceptibility pattern among pregnant women attending at Antenatal Clinic in Dil Chora Referral Hospital, Dire Dawa, Eastern Ethiopia. Ther Clin Risk Manag. 2016;12:251-60.
Jacob ST, Moore CC, Banura P, Pinkerton R, Meya D, Opendi P, et al. Severe sepsis in two Ugandan hospitals: a prospective observational study of management and outcomes in a predominantly HIV-1 infected population. PLoS One. 2009;4:0007782.
Alebachew G, Teka B, Endris M, Shiferaw Y, Tessema B. Etiologic Agents of Bacterial Sepsis and Their Antibiotic Susceptibility Patterns among Patients Living with Human Immunodeficiency Virus at Gondar University Teaching Hospital, Northwest Ethiopia. Biomed Res Int. 2016;5371875:23.
Arthur G, Nduba VN, Kariuki SM, Kimari J, Bhatt SM, Gilks CF. Trends in bloodstream infections among human immunodeficiency virus-infected adults admitted to a hospital in Nairobi, Kenya, during the last decade. Clin Infect Dis. 2001;33:248-56.
Kiertiburanakul S, Watcharatipagorn S, Chongtrakool P, Santanirand P. Epidemiology of bloodstream infections and predictive factors of mortality among HIV-infected adult patients in Thailand in the era of highly active antiretroviral therapy. Jpn J Infect Dis. 2012;65:28-32.
Ssekitoleko R, Pinkerton R, Muhindo R, Bhagani S, Moore CC. Aggregate evaluable organ dysfunction predicts in-hospital mortality from sepsis in Uganda. Am J Trop Med Hyg. 2011;85:697-702.
Piette A, Verschraegen G. Role of coagulase-negative staphylococci in human disease. Vet Microbiol. 2009;134:45-54.
Sobhani A, Javanbakht HSS. Drug resistance pattern in isolated bacteria from blood cultures. Acta Medica Iranica. 2004;42:46-9.
Awolude OA, Adesina OA, Oladokun A, Mutiu WB, Adewole IF. Asymptomatic bacteriuria among HIV positive pregnant women. Virulence. 2010;1:130-3.
Vazquez-Guillamet C, Kollef MH. Treatment of Gram-positive infections in critically ill patients. BMC Infect Dis. 2014;14:1471-2334.
Crump JA, Ramadhani HO, Morrissey AB, Saganda W, Mwako MS, Yang LY, et al. Invasive bacterial and fungal infections among hospitalized HIV-infected and HIV-uninfected adults and adolescents in northern Tanzania. Clin Infect Dis. 2011;52:341-8.
Johnson MT, Reichley R, Hoppe-Bauer J, Dunne WM, Micek S, Kollef M. Impact of previous antibiotic therapy on outcome of Gram-negative severe sepsis. Crit Care Med. 2011;39:1859-65.
Zilberberg MD, Shorr AF, Micek ST, Vazquez-Guillamet C, Kollef MH. Multi-drug resistance, inappropriate initial antibiotic therapy and mortality in Gram-negative severe sepsis and septic shock: a retrospective cohort study. Crit Care. 2014;18:014-0596.
Ghadiri H, Vaez H, Khosravi S, Soleymani E. The antibiotic resistance profiles of bacterial strains isolated from patients with hospital-acquired bloodstream and urinary tract infections. Crit Care Res Pract. 2012;890797:12.
Poulakou G, Kontopidou FV, Paramythiotou E, Kompoti M, Katsiari M, Mainas E, et al. Tigecycline in the treatment of infections from multi-drug resistant gram-negative pathogens. J Infect. 2009;58:273-84.

References

Balk RA. Systemic inflammatory response syndrome (SIRS): where did it come from and is it still relevant today? Virulence. 2014;5:20-6.

Baharoon S, Telmesani A, Tamim H, Alsafi E, Aljohani S, Mahmoud E, et al. Community- versus nosocomial-acquired severe sepsis and septic shock in patients admitted to a tertiary intensive care in Saudi Arabia, etiology and outcome. J Infect Public Health. 2015;8:418-24.

Zadeh AO, SeyedAlinaghi S, Hassanzad FF, Hajizadeh M, Mohamadi S, Emamzadeh-Fard S, et al. Prevalence of HIV infection and the correlates among homeless in Tehran, Iran. Asian Pac J Trop Biomed. 2014;4:65-8.

Silva JM, Jr., dos Santos Sde S. Sepsis in AIDS patients: clinical, etiological and inflammatory characteristics. J Int AIDS Soc. 2013;16:17344.

Moreira J, Amancio R, Coelho L, Andrade H, Japiassú A. Interactions between HIV Infection and Sepsis among Critically Ill Patients: A Systematic Review. Clin Res HIV/AIDS. 2015;2:1021.

Adeyemi AI, Sulaiman AA, Solomon BB, Chinedu OA, Victor IA. Bacterial bloodstream infections in HIV-infected adults attending a Lagos teaching hospital. J Health Popul Nutr. 2010;28:318-26.

Varma JK, McCarthy KD, Tasaneeyapan T, Monkongdee P, Kimerling ME, Buntheoun E, et al. Bloodstream infections among HIV-infected outpatients, Southeast Asia. Emerg Infect Dis. 2010;16:1569-75.

Wayne P. Performance Standards for Antimicrobial Susceptibility Testing. Clinical and Laboratory Standards Institute (CLSI) 2015;25th Informational Supplement.

Martin GS. Sepsis, severe sepsis and septic shock: changes in incidence, pathogens and outcomes. Expert Rev Anti Infect Ther. 2012;10:701-6.

Amancio RT, Japiassu AM, Gomes RN, Mesquita EC, Assis EF, Medeiros DM, et al. The innate immune response in HIV/AIDS septic shock patients: a comparative study. PLoS One. 2013;8.

Shehab El-Din EM, El-Sokkary MM, Bassiouny MR, Hassan R. Epidemiology of Neonatal Sepsis and Implicated Pathogens: A Study from Egypt. Biomed Res Int. 2015;509484:4.

Japiassu AM, Amancio RT, Mesquita EC, Medeiros DM, Bernal HB, Nunes EP, et al. Sepsis is a major determinant of outcome in critically ill HIV/AIDS patients. Crit Care. 2010;14:10.

Croda J, Croda MG, Neves A, De Sousa dos Santos S. Benefit of antiretroviral therapy on survival of human immunodeficiency virus-infected patients admitted to an intensive care unit. Crit Care Med. 2009;37:1605-11.

Afessa B, Green B. Clinical course, prognostic factors, and outcome prediction for HIV patients in the ICU. The PIP (Pulmonary complications, ICU support, and prognostic factors in hospitalized patients with HIV) study. Chest. 2000;118:138-45.

Huang L, Quartin A, Jones D, Havlir DV. Intensive care of patients with HIV infection. New England Journal of Medicine. 2006;355:173-81.

Casalino E, Wolff M, Ravaud P, Choquet C, Bruneel F, Regnier B. Impact of HAART advent on admission patterns and survival in HIV-infected patients admitted to an intensive care unit. Aids. 2004;18:1429-33.

Povoa P, Salluh JI. Biomarker-guided antibiotic therapy in adult critically ill patients: a critical review. Ann Intensive Care. 2012;2:2110-5820.

Phe T, Vlieghe E, Reid T, Harries AD, Lim K, Thai S, et al. Does HIV status affect the aetiology, bacterial resistance patterns and recommended empiric antibiotic treatment in adult patients with bloodstream infection in Cambodia? Trop Med Int Health. 2013;18:485-94.

Nadjm B, Mtove G, Amos B, Walker NF, Diefendal H, Reyburn H, et al. Severe febrile illness in adult hospital admissions in Tanzania: a prospective study in an area of high malaria transmission. Trans R Soc Trop Med Hyg. 2012;106:688-95.

Mayanja BN, Todd J, Hughes P, Van der Paal L, Mugisha JO, Atuhumuza E, et al. Septicaemia in a population-based HIV clinical cohort in rural Uganda, 1996-2007: incidence, aetiology, antimicrobial drug resistance and impact of antiretroviral therapy. Trop Med Int Health. 2010;15:697-705.

Peters RP, Zijlstra EE, Schijffelen MJ, Walsh AL, Joaki G, Kumwenda JJ, et al. A prospective study of bloodstream infections as cause of fever in Malawi: clinical predictors and implications for management. Trop Med Int Health. 2004;9:928-34.

Grozdanovski K, Milenkovic Z, Demiri I, Spasovska K. Prediction of outcome from community-acquired severe sepsis and septic shock in tertiary-care university hospital in a developing country. Crit Care Res Pract. 2012;182324:17.

Muyanja SZ, Larke N, Rutebarika D, Kaddu I, Nakubulwa S, Levin J, et al. Decreasing trends of bacteraemia among HIV-infected Ugandan adults: incidence, aetiology, clinical outcomes and effect of antiretroviral therapy in a semi-urban setting (2000-2008). Trop Med Int Health. 2011;16:756-65.

Greenberg JA, Lennox JL, Martin GS. Outcomes for critically ill patients with HIV and severe sepsis in the era of highly active antiretroviral therapy. J Crit Care. 2012;27:51-7.

Novosad SA, Sapiano MR, Grigg C, Lake J, Robyn M, Dumyati G, et al. Vital Signs: Epidemiology of Sepsis: Prevalence of Health Care Factors and Opportunities for Prevention. MMWR Morb Mortal Wkly Rep. 2016;65:864-9.

Barati M, Taher MT, Abasi R, Zadeh MM, Barati M, Shamshiri AR. Bacteriological profile and antimicrobial. Archives of Clinical Infectious Diseases. 2009;4:87-95.

Sedigh Ebrahim-Saraie H, Motamedifar M, Mansury D, Halaji M, Hashemizadeh Z, Ali-Mohammadi Y. Bacterial Etiology and Antibacterial Susceptibility Patterns of Pediatric Bloodstream Infections: A Two Year Study From Nemazee Hospital, Shiraz, Iran. J Compr Ped. 2016;7:e29929.

Farajnia S, Alikhani MY, Ghotaslou R, Naghili B, Nakhlband A. Causative agents and antimicrobial susceptibilities of urinary tract infections in the northwest of Iran. Int J Infect Dis. 2009;13:140-4.

Derese B, Kedir H, Teklemariam Z, Weldegebreal F, Balakrishnan S. Bacterial profile of urinary tract infection and antimicrobial susceptibility pattern among pregnant women attending at Antenatal Clinic in Dil Chora Referral Hospital, Dire Dawa, Eastern Ethiopia. Ther Clin Risk Manag. 2016;12:251-60.

Jacob ST, Moore CC, Banura P, Pinkerton R, Meya D, Opendi P, et al. Severe sepsis in two Ugandan hospitals: a prospective observational study of management and outcomes in a predominantly HIV-1 infected population. PLoS One. 2009;4:0007782.

Alebachew G, Teka B, Endris M, Shiferaw Y, Tessema B. Etiologic Agents of Bacterial Sepsis and Their Antibiotic Susceptibility Patterns among Patients Living with Human Immunodeficiency Virus at Gondar University Teaching Hospital, Northwest Ethiopia. Biomed Res Int. 2016;5371875:23.

Arthur G, Nduba VN, Kariuki SM, Kimari J, Bhatt SM, Gilks CF. Trends in bloodstream infections among human immunodeficiency virus-infected adults admitted to a hospital in Nairobi, Kenya, during the last decade. Clin Infect Dis. 2001;33:248-56.

Kiertiburanakul S, Watcharatipagorn S, Chongtrakool P, Santanirand P. Epidemiology of bloodstream infections and predictive factors of mortality among HIV-infected adult patients in Thailand in the era of highly active antiretroviral therapy. Jpn J Infect Dis. 2012;65:28-32.

Ssekitoleko R, Pinkerton R, Muhindo R, Bhagani S, Moore CC. Aggregate evaluable organ dysfunction predicts in-hospital mortality from sepsis in Uganda. Am J Trop Med Hyg. 2011;85:697-702.

Piette A, Verschraegen G. Role of coagulase-negative staphylococci in human disease. Vet Microbiol. 2009;134:45-54.

Sobhani A, Javanbakht HSS. Drug resistance pattern in isolated bacteria from blood cultures. Acta Medica Iranica. 2004;42:46-9.

Awolude OA, Adesina OA, Oladokun A, Mutiu WB, Adewole IF. Asymptomatic bacteriuria among HIV positive pregnant women. Virulence. 2010;1:130-3.

Vazquez-Guillamet C, Kollef MH. Treatment of Gram-positive infections in critically ill patients. BMC Infect Dis. 2014;14:1471-2334.

Crump JA, Ramadhani HO, Morrissey AB, Saganda W, Mwako MS, Yang LY, et al. Invasive bacterial and fungal infections among hospitalized HIV-infected and HIV-uninfected adults and adolescents in northern Tanzania. Clin Infect Dis. 2011;52:341-8.

Johnson MT, Reichley R, Hoppe-Bauer J, Dunne WM, Micek S, Kollef M. Impact of previous antibiotic therapy on outcome of Gram-negative severe sepsis. Crit Care Med. 2011;39:1859-65.

Zilberberg MD, Shorr AF, Micek ST, Vazquez-Guillamet C, Kollef MH. Multi-drug resistance, inappropriate initial antibiotic therapy and mortality in Gram-negative severe sepsis and septic shock: a retrospective cohort study. Crit Care. 2014;18:014-0596.

Ghadiri H, Vaez H, Khosravi S, Soleymani E. The antibiotic resistance profiles of bacterial strains isolated from patients with hospital-acquired bloodstream and urinary tract infections. Crit Care Res Pract. 2012;890797:12.

Poulakou G, Kontopidou FV, Paramythiotou E, Kompoti M, Katsiari M, Mainas E, et al. Tigecycline in the treatment of infections from multi-drug resistant gram-negative pathogens. J Infect. 2009;58:273-84.

Author biographies is not available.