Multi Drug Resistant Uropathogens in HIV: Are They A Threat to Community?

Introduction: Untreated Urinary tract infections accounts for 7-60% of opportunistic infections in immunocompromised hosts. Asymptomatic bacteriuria is one among the important causes of opportunistic infections in HIV seropositive. Urinary tract infections became quite alarming as isolated uropathogens exhibits high percentage resistance to almost all antibiotics. Limited data is available from India on the frequency of asymptomatic bacteriuria in HIV seropositive. Aims & Objectives: The present study was taken up to know the prevalence of asymptomatic urinary tract infections among HIV patients. Materials & Methods: 200 HIV seropositive patients without any complaints of urinary symptoms were included in the study. Patients with urinary tract abnormalities, diabetes mellitus, pregnancy etc. were excluded from the study. Patient’s history of antibiotics & anti retroviral treatment intake was noted. Urine samples were processed by standard protocols. Antibiotic susceptibility testing was performed using Kirby-Bauer’s disk diffusion method. CD4 counts were done using FACS Calibur. Results: Among 200 HIV patients in the study, 100 patients were on antiretroviral treatment. Out of 200 urine samples, 60 (30%) samples showed significant growth. 40 patients with significant bacteriuria were on antiretroviral treatment. Out of 60 samples, 48 (80%) isolates were bacteria & 12 (20%) were identified as Candida species.Commonest bacterial isolates were Staphylococcus aureus 34 (56.66%), Enterococcus species 09 (15%), Escherichia coli 03 (5%). Isolates showing resistance to three or more than three categories of antibiotics were considered as multi drug resistant bacteria. 28 bacterial isolates were showing multi drug resistance.15 (44.11%) of Staphylococcus aureus were methicillin resistant. Discussion: Higher prevalence of resistant uropathogens in HIV patients is a definitive threat. The early identification of multi drug resistant uropathogens in these patients and their proper treatment will help in patient betterment & also avoids the spread of these bacteria to the community. Conclusion: Routine urine screening of HIV seropositive might help in the early detection of multi drug resistant uropathogens.