Assessing Antibiotic-Resistance Patterns and Clinical outcomes among People-Living with Hiv/Aids with Features of Sepsis, in Northern Tanzania

Abstract

Mortality in people living with human immunodeficiency virus (PLHIV) remains substantial in Sub-Saharan Africa. Despite sepsis being the major cause of mortality in PLHIV, its optimal management remains questionable due to poorly characterized etiological agents as well as effective antimicrobials. This study aimed to assess etiological agents in PLHIV with sepsis, antibiotic susceptibility and mortality determinants. A prospective cohort design was conducted at three referral hospitals in Kilimanjaro region from May-December 2021. Patients with sepsis were screened for Tuberculosis (TB) using urine lateral flow–lipoarabinomannan (LF‑LAM) and sputum Xpert®-Mycobacterium tuberculosis (MTB)/rifampicin (RIF) assays. Microbiological diagnostic tests as well as general clinical laboratory tests were also done. Anti‑TB and broad-spectrum antibiotics were initiated accordingly. Patients were followed-up for 28 days. Variables were compared using an independent Chi-Square/t-tests. 98 patients were enrolled with a mean age of 44 (SD 12.9) years old with 59 (60.2%) being females. The TB was detected in 36 (36.7%) patients, with LF-LAM detecting 12 cases missed by XpertMTB/RIF. Isolated pathogens considered also as the cause of sepsis in patients with TB and those without TB included Staphylococcus aureus (4(11.1%) vs 6(9.7%)), Streptococcus pneumonia (3(8.3%) vs 2(3.2%)), Cryptococcal Spp. (3(8.3%) vs 2(3.2%)), respectively. Abnormal CBC, CRP, INR was in 31 (31.6%), 49(50%) and 40 (40.8%), respectively. The S. aureus isolates demonstrated 90% resistance against cotrimoxazole and low rate (10%) against gentamicin. Mortality was (9.2%) and was associated with malnutrition (p=0.000), high MEWS scores (p=0.000), Karnofsky score<50% (p= 0.028) and higher INR values (p=0.025). Multiple pathogens contributed to sepsis in PLHIV that necessitate frequent use of antibiotics and leading to high antibiotic-resistance among bacterial isolates. Also, malnutrition and prolonged INR were considered a risk factor for mortality.