Urinary tract infection among HIV-infected patients
ABSTRACT
Objective: The goal of this study was to determine the frequency of urinary tract infection (UTI) among the out-patients and in-patients who are infected with human immune virus (HIV); and to compare reagent strip (nitrite) with microscopy and culture in identifying significant bacteriuria; and the effect of commonly used antibiotics on the isolated bacteria.
Methods: Three hundred and forty two urine samples were obtained from female and male adults (>12 years of age) and children (<12 years of age). Of these, 137 were inpatients admitted to Benghazi Infectious Diseases Centre and Immunity (BCIDI) and 205 outpatients during the period from June 2006 to November 2007.
Results: Of 25 positive cultures from 342 specimens (7.3%); 18 (72%) were females and 7 (28%) were males. Nitrite test, pyuria, and bacteriuria had a sensitivity of 4%; 60 %; and 12 % for detecting UTI and specificity of 100%; 91.3 % and 97.2 %, respectively. Escherichia coli was seen in 8 (32%) of cases followed by Klebsiella pneumoniae 6 (24%); Klebsiella terrigena 3 (12%); Staphylococcus aureus 3 (12%), Staphylococcus epidermidis 2 (8%), and 1 (4%) each of Staphylococcus saprophyticus; Enterobacter aerogenes; Citrobacter koseri; Proteus mirabilis. All bacterial isolates showed high resistance rates to ampicillin, nitrofurantoin, amoxicillin/clavulanic acid and Trimethoprim/sulfamethoxazole.
Conclusion: The results suggested that microscopic urinalysis or the nitrite dipstick alone can not accurately predict positive urine cultures. In view of the high resistance rates to most of the commonly used antibacterial drugs, caution must be applied when treating HIV patients infected with UTI.
INTRODUCTION
HIV-positive patients are liable to acquire opportunistic infections. Their liability to acquire other common infectious conditions is less frequently reported (1). People with AIDS are predisposed to urinary tract infection (UTI) by uncommon bacteria and pathogens, e.g. fungi, parasites and viruses, which may affect any portion of the urinary tract, including the adrenals, kidneys, bladder, prostate, testes and epididymes (1). Patients with AIDS have UTI more frequently than HIV-positive patients without AIDS; the reported incidence of bacteriuria (UTI) in patients with AIDS is 7-50% (1). Symptoms include dysuria, frequency, urgency, fever, lumbar pain and haematuria, although many patients are asymptomatic. Pyuria has been noted in up to 52% of patients with associated UTI in 20%. The most common bacterial pathogens in HIV-infected patients are Escherichia coli, Enterobacter (Enterococci), Pseudomonas aeruginosa, Proteus spp., Klebsiella, Acinetobacter, Staphylococcus aureus, group D streptococcus, Serrratia and Salmonella spp. (2). Urine cultures may be negative due to the fact hat the majority of patients are likely receiving treatment including prophylactic antimicrobials against opportunistic infections (2).
The purpose of this study was to assess the frequency of UTI among HIV infected patients, and to compare the reagent strip testing (nitrite) with microscopy and culture in identifying significantbacteriuria.Theeffectofantibioticson the isolated bacteria was also investigated.
Objective: The goal of this study was to determine the frequency of urinary tract infection (UTI) among the out-patients and in-patients who are infected with human immune virus (HIV); and to compare reagent strip (nitrite) with microscopy and culture in identifying significant bacteriuria; and the effect of commonly used antibiotics on the isolated bacteria.
Methods: Three hundred and forty two urine samples were obtained from female and male adults (>12 years of age) and children (<12 years of age). Of these, 137 were inpatients admitted to Benghazi Infectious Diseases Centre and Immunity (BCIDI) and 205 outpatients during the period from June 2006 to November 2007.
Results: Of 25 positive cultures from 342 specimens (7.3%); 18 (72%) were females and 7 (28%) were males. Nitrite test, pyuria, and bacteriuria had a sensitivity of 4%; 60 %; and 12 % for detecting UTI and specificity of 100%; 91.3 % and 97.2 %, respectively. Escherichia coli was seen in 8 (32%) of cases followed by Klebsiella pneumoniae 6 (24%); Klebsiella terrigena 3 (12%); Staphylococcus aureus 3 (12%), Staphylococcus epidermidis 2 (8%), and 1 (4%) each of Staphylococcus saprophyticus; Enterobacter aerogenes; Citrobacter koseri; Proteus mirabilis. All bacterial isolates showed high resistance rates to ampicillin, nitrofurantoin, amoxicillin/clavulanic acid and Trimethoprim/sulfamethoxazole.
Conclusion: The results suggested that microscopic urinalysis or the nitrite dipstick alone can not accurately predict positive urine cultures. In view of the high resistance rates to most of the commonly used antibacterial drugs, caution must be applied when treating HIV patients infected with UTI.
INTRODUCTION
HIV-positive patients are liable to acquire opportunistic infections. Their liability to acquire other common infectious conditions is less frequently reported (1). People with AIDS are predisposed to urinary tract infection (UTI) by uncommon bacteria and pathogens, e.g. fungi, parasites and viruses, which may affect any portion of the urinary tract, including the adrenals, kidneys, bladder, prostate, testes and epididymes (1). Patients with AIDS have UTI more frequently than HIV-positive patients without AIDS; the reported incidence of bacteriuria (UTI) in patients with AIDS is 7-50% (1). Symptoms include dysuria, frequency, urgency, fever, lumbar pain and haematuria, although many patients are asymptomatic. Pyuria has been noted in up to 52% of patients with associated UTI in 20%. The most common bacterial pathogens in HIV-infected patients are Escherichia coli, Enterobacter (Enterococci), Pseudomonas aeruginosa, Proteus spp., Klebsiella, Acinetobacter, Staphylococcus aureus, group D streptococcus, Serrratia and Salmonella spp. (2). Urine cultures may be negative due to the fact hat the majority of patients are likely receiving treatment including prophylactic antimicrobials against opportunistic infections (2).
The purpose of this study was to assess the frequency of UTI among HIV infected patients, and to compare the reagent strip testing (nitrite) with microscopy and culture in identifying significantbacteriuria.Theeffectofantibioticson the isolated bacteria was also investigated.
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