Antimicrobial Resistance in Urinary Tract Infections Among HIV-Positive Populations

The convergence of human immunodeficiency virus (HIV) infection and antimicrobial resistance in urinary tract infections poses a significant clinical challenge. Impaired cellular immunity, reflected by declining CD4+ T-cell counts, predisposes people living with HIV to recurrent and complicated urinary tract infections. Common uropathogens include Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus, many of which harbour resistance determinants such as extended-spectrum β-lactamases and methicillin-resistance genes. Widespread use of prophylactic and empirical antibiotics, including trimethoprim-sulfamethoxazole, has driven the emergence of multidrug-resistant strains, often exhibiting cross-resistance to fluoroquinolones and cephalosporins. Global surveillance and targeted antimicrobial susceptibility testing are vital to inform effective therapeutic strategies. New rapid diagnostics, stewardship interventions and immunological restoration through antiretroviral therapy have shown promise in reducing incidence and resistance. However, gaps remain in understanding regional variations, the impact of antiretroviral regimens on microbial ecology and the optimisation of empirical treatment guidelines in resource-limited settings.

Research from Nature Portfolio

A cross-sectional study at a tertiary hospital in southern Ethiopia characterised bacterial isolates from HIV-positive patients presenting with urinary symptoms. The prevalence of culture-confirmed urinary tract infection was 10.3 per cent, with Escherichia coli accounting for over two-thirds of isolates. Women and individuals with CD4+ counts below 200 cells/µl or a history of prior urinary infection were at increased risk. Antimicrobial susceptibility testing revealed high levels of resistance to ampicillin, tetracycline and cotrimoxazole, whereas nitrofurantoin, ceftriaxone, gentamicin and meropenem retained substantial activity. Over three-quarters of isolates were classified as multidrug resistant, underscoring the need for routine sensitivity testing and stewardship to guide empirical therapy.

Antimicrobial Resistance in Urinary Tract Infections Among HIV-Positive Populations publication trend

The graph below shows the total number of articles in antimicrobial resistance in urinary tract infections among hiv-positive populations across all publications each year (not limited to Nature Index journals).

Technical terms

Antimicrobial resistance: The ability of microorganisms to survive exposure to drugs designed to inhibit or kill them, leading to treatment failure.

Multidrug resistance (MDR): Resistance of a bacterial isolate to at least three classes of antimicrobial agents.

Extended-spectrum β-lactamases (ESBLs): Enzymes produced by certain bacteria that confer resistance to penicillins, cephalosporins and aztreonam.

CD4+ T-cell count: A laboratory measure of T-helper lymphocyte concentration, reflecting immune status in people living with HIV.

Antiretroviral therapy (ART): Combination drug treatment aimed at suppressing HIV replication and restoring immune function.

References

1. Correlation of CD4+ count and viral load with urinary tract infection and antimicrobial resistance pattern of bacterial uropathogens among HIV patients in Wolaita Sodo, South Ethiopia. Frontiers in Microbiology (2024).
2. Antimicrobial susceptibility patterns of urinary tract infections causing bacterial isolates and associated risk factors among HIV patients in Tigray, Northern Ethiopia. BMC Microbiology (2024).
3. The association between antimicrobial resistance and HIV infection: a systematic review and meta-analysis. Clinical Microbiology and Infection (2021).
4. Bacterial associated urinary tract infection, risk factors, and drug susceptibility profile among adult people living with HIV at Haswassa University Comprehensive Specialized Hospital, Hawassa, Southern Esthiopia. Scientific Reports (2020).