Non-Tuberculous Bacterial Infections among Hospitalized People Living with HIV in a Senegalese Referral Centre: Clinical Presentation, Bacterial Spectrum, Resistance Patterns and Outcomes
Introduction: People living with HIV (PLHIV), particularly those with advanced immunosuppression, remain vulnerable to severe non-tuberculous bacterial infections. This study described the clinical presentation, bacterial isolates, antimicrobial susceptibility patterns, resistance phenotypes, and outcome profile of microbiologically documented non-tuberculous bacterial infections among PLHIV hospitalized at the Infectious and Tropical Diseases Department (SMIT) of Fann hospital in Dakar, Senegal. PatientsandMethods: A retrospective descriptive study was conducted in the SMIT of Fann hospital, from March 2019 to December 2022. Demographic, clinical, laboratory, microbiological, antimicrobial susceptibility and outcome data were extracted. Results: Thirty-six patients were included after screening bacteriology-linked HIV inpatient records. Median age was 44.5 years (IQR: 36.0 - 53.0) and 55.6% were female. CD4 count was available for 10 patients, of whom 90.0% had less than 200 cells/μL. Prior hospitalization within six months was recorded in 22/36 patients (61.1%; 22/28 documented responses), and prior antibiotic exposure in 13/36 (36.1%; 13/14 documented responses). Median symptom duration before admission was 30 days and median hospital stay was 23 days. Urine and blood cultures were the main positive specimens. Overall, 90 specimens yielded 57 isolates and 16 species/taxa. Gram-negative bacteria represented 59.6% of isolates. Leading pathogens were Escherichiacoli (26.3%), Klebsiellapneumoniae (21.1%) and Staphylococcusaureus (19.3%). ESBL production was detected in 61.3% of Enterobacterales. MRSA represented 36.4% of S.aureus isolates. Resistance was high to amoxicillin-clavulanate (90.0%), cotrimoxazole (83.3%), ceftriaxone (71.4%) and ciprofloxacin (63.4%); imipenem resistance was 7.4%. Antibiotic reassessment was recorded in 27/33 documented cases (81.8%). In-hospital case fatality was 33.3%. Conclusion: In this referral centre, microbiologically documented non-tuberculous bacterial infections in PLHIV were marked by urinary and bloodstream predominance, ESBL-producing Enterobacterales, resistant staphylococci and high case fatality. The findings support early bacteriological documentation, therapeutic reassessment, antimicrobial stewardship and strengthened infection prevention and control.
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