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Rubio Garcia E, Casadellà M, Parera M, Vila J, Paredes R, Noguera-Julian M. Gut resistome linked to sexual preference and HIV infection. BMC Microbiol 2024; 24:201. [PMID: 38851693 PMCID: PMC11162057 DOI: 10.1186/s12866-024-03335-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 05/16/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND People living with HIV (PLWH) are at increased risk of acquisition of multidrug resistant organisms due to higher rates of predisposing factors. The gut microbiome is the main reservoir of the collection of antimicrobial resistance determinants known as the gut resistome. In PLWH, changes in gut microbiome have been linked to immune activation and HIV-1 associated complications. Specifically, gut dysbiosis defined by low microbial gene richness has been linked to low Nadir CD4 + T-cell counts. Additionally, sexual preference has been shown to strongly influence gut microbiome composition in PLWH resulting in different Prevotella or Bacteroides enriched enterotypes, in MSM (men-who-have-sex-with-men) or no-MSM, respectively. To date, little is known about gut resistome composition in PLWH due to the scarcity of studies using shotgun metagenomics. The present study aimed to detect associations between different microbiome features linked to HIV-1 infection and gut resistome composition. RESULTS Using shotgun metagenomics we characterized the gut resistome composition of 129 HIV-1 infected subjects showing different HIV clinical profiles and 27 HIV-1 negative controls from a cross-sectional observational study conducted in Barcelona, Spain. Most no-MSM showed a Bacteroides-enriched enterotype and low microbial gene richness microbiomes. We did not identify differences in resistome diversity and composition according to HIV-1 infection or immune status. However, gut resistome was more diverse in MSM group, Prevotella-enriched enterotype and gut micorbiomes with high microbial gene richness compared to no-MSM group, Bacteroides-enriched enterotype and gut microbiomes with low microbial gene richness. Additionally, gut resistome beta-diversity was different according to the defined groups and we identified a set of differentially abundant antimicrobial resistance determinants based on the established categories. CONCLUSIONS Our findings reveal a significant correlation between gut resistome composition and various host variables commonly associated with gut microbiome, including microbiome enterotype, microbial gene richness, and sexual preference. These host variables have been previously linked to immune activation and lower Nadir CD4 + T-Cell counts, which are prognostic factors of HIV-related comorbidities. This study provides new insights into the relationship between antibiotic resistance and clinical characteristics of PLWH.
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Affiliation(s)
- Elisa Rubio Garcia
- Department of Microbiology, CDB, Hospital Clinic, University of Barcelona, Barcelona, Spain.
- Molecuar Core Facilty, Hospital Clínic de Barcelona, Barcelona, Spain.
- ISGlobal Barcelona Institute for Global Health, Barcelona, Spain.
| | | | | | - Jordi Vila
- Department of Microbiology, CDB, Hospital Clinic, University of Barcelona, Barcelona, Spain
- ISGlobal Barcelona Institute for Global Health, Barcelona, Spain
- Infectious Disease Networking Biomedical Research Center (CIBERINFEC), Carlos III Health Institute, Madrid, Spain
| | - Roger Paredes
- IrsiCaixa, Ctra de Canyet S/N, 08916, Badalona, Spain
- Universitat de Vic-Universitat Central de Catalunya, Vic, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Department of Infectious Diseasest &, Lluita Contra La SIDA Foundation, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
- Infectious Disease Networking Biomedical Research Center (CIBERINFEC), Carlos III Health Institute, Madrid, Spain
| | - Marc Noguera-Julian
- IrsiCaixa, Ctra de Canyet S/N, 08916, Badalona, Spain
- Universitat de Vic-Universitat Central de Catalunya, Vic, Spain
- Infectious Disease Networking Biomedical Research Center (CIBERINFEC), Carlos III Health Institute, Madrid, Spain
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Rubio-Garcia E, Ferrando N, Martin N, Ballesté-Delpierre C, Miró JM, Paredes R, Casals-Pascual C, Vila J. In vitro antibacterial activity of antiretroviral drugs on key commensal bacteria from the human microbiota. Front Cell Infect Microbiol 2024; 13:1306430. [PMID: 38259963 PMCID: PMC10801051 DOI: 10.3389/fcimb.2023.1306430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Antiretroviral therapy has improved life expectancy in HIV-infected patients. However, people living with HIV under antiretroviral therapy are at higher risks of developing chronic complications and acquiring multidrug resistant bacteria than healthy population. These factors have been associated with shifts in gut microbiome composition and immune activation. It is unclear how antiretroviral drugs affect gut microbiota composition, but it has been observed that antiretroviral treatment is not able to fully restore gut health after HIV infection. Additionally, some antiretroviral drugs have shown antibacterial activity suggesting that these drugs could have a direct impact on the human microbiome composition. Methods We determined the in vitro antibacterial activity of 16 antiretroviral drugs against a set of key clinically relevant and human commensal bacterial strains. Results Our results demonstrate that 5 antiretroviral drugs have in vitro antibacterial activity against gut and vaginal human commensal bacteria. Zidovudine has antibacterial activity against Escherichia coli, Klebsiella pneumoniae and Prevotella bivia, abacavir against Gardnerella vaginalis, efavirenz against G. vaginalis and P. bivia and bictegravir against Enterococcus spp. and G. vaginalis. Moreover, we describe for the first time that elvitegravir has antibacterial activity against G. vaginalis and P. bivia and, most importantly, against vancomycin-resistant Enterococcus spp. and methicillin-resistant Staphylococcus aureus strains with MIC values of 4-16 and 4 µg/mL, respectively showing high level of effectiveness against the tested multidrug-resistant bacteria. Discussion Our results underscore that some antiretroviral drugs may influence the human microbiota composition. In addition, we report the potential use of elvitegravir to treat multidrug-resistant Gram-positive bacteria warranting the need of clinical studies to repurpose this antiretroviral drug.
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Affiliation(s)
- Elisa Rubio-Garcia
- Department of Clinical Microbiology, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic of Barcelona, Barcelona, Spain
- Molecular Core Facility, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic of Barcelona, Barcelona, Spain
- Departament de Fonaments Clínics, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Núria Ferrando
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Núria Martin
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Clara Ballesté-Delpierre
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Infectious Disease Networking Biomedical Research Center, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose M. Miró
- Infectious Disease Networking Biomedical Research Center, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Infectious diseases Service. Hospital Clínic-IDIBAPS. University of Barcelona, Barcelona, Spain
| | - Roger Paredes
- Infectious Disease Networking Biomedical Research Center, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Fundació Lluita Contra les Infeccions, Department of Infectious Diseases, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
- IrsiCaixa AIDS Research Institute, Badalona, Catalonia, Spain
- Center for Global Health and Diseases, Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Climent Casals-Pascual
- Department of Clinical Microbiology, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic of Barcelona, Barcelona, Spain
- Departament de Fonaments Clínics, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Infectious Disease Networking Biomedical Research Center, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Vila
- Department of Clinical Microbiology, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic of Barcelona, Barcelona, Spain
- Departament de Fonaments Clínics, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Infectious Disease Networking Biomedical Research Center, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Henderson HI, Napravnik S, Kosorok MR, Gower EW, Kinlaw AC, Aiello AE, Williams B, Wohl DA, van Duin D. Predicting Risk of Multidrug-Resistant Enterobacterales Infections Among People With HIV. Open Forum Infect Dis 2022; 9:ofac487. [PMID: 36225740 PMCID: PMC9547514 DOI: 10.1093/ofid/ofac487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/15/2022] [Indexed: 11/14/2022] Open
Abstract
Background Medically vulnerable individuals are at increased risk of acquiring multidrug-resistant Enterobacterales (MDR-E) infections. People with HIV (PWH) experience a greater burden of comorbidities and may be more susceptible to MDR-E due to HIV-specific factors. Methods We performed an observational study of PWH participating in an HIV clinical cohort and engaged in care at a tertiary care center in the Southeastern United States from 2000 to 2018. We evaluated demographic and clinical predictors of MDR-E by estimating prevalence ratios (PRs) and employing machine learning classification algorithms. In addition, we created a predictive model to estimate risk of MDR-E among PWH using a machine learning approach. Results Among 4734 study participants, MDR-E was isolated from 1.6% (95% CI, 1.2%-2.1%). In unadjusted analyses, MDR-E was strongly associated with nadir CD4 cell count ≤200 cells/mm3 (PR, 4.0; 95% CI, 2.3-7.4), history of an AIDS-defining clinical condition (PR, 3.7; 95% CI, 2.3-6.2), and hospital admission in the prior 12 months (PR, 5.0; 95% CI, 3.2-7.9). With all variables included in machine learning algorithms, the most important clinical predictors of MDR-E were hospitalization, history of renal disease, history of an AIDS-defining clinical condition, CD4 cell count nadir ≤200 cells/mm3, and current CD4 cell count 201-500 cells/mm3. Female gender was the most important demographic predictor. Conclusions PWH are at risk for MDR-E infection due to HIV-specific factors, in addition to established risk factors. Early HIV diagnosis, linkage to care, and antiretroviral therapy to prevent immunosuppression, comorbidities, and coinfections protect against antimicrobial-resistant bacterial infections.
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Affiliation(s)
- Heather I Henderson
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael R Kosorok
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily W Gower
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alan C Kinlaw
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, North Carolina, USA.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Allison E Aiello
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Billy Williams
- Clinical Microbiology Laboratory, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
| | - David A Wohl
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David van Duin
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Henderson HI, Ruegsegger L, Alby K, Smedberg JR, Hill BM, Brown D, Wohl DA, Napravnik S, Van Duin D. Antimicrobial-resistant Enterobacterales colonization in people with HIV. JAC Antimicrob Resist 2022; 4:dlac082. [PMID: 35935279 PMCID: PMC9345307 DOI: 10.1093/jacamr/dlac082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/14/2022] [Indexed: 01/16/2023] Open
Abstract
Background People with HIV (PWH) may be at increased risk for MDR Enterobacterales (MDR-E) infection or colonization, relative to individuals without HIV, due to a greater burden of comorbidities as well as HIV-related intestinal inflammation and microbiota alterations. Objectives To characterize antibiotic susceptibility of enteric Enterobacterales and risk factors for antimicrobial-resistant bacterial infections in a sample of PWH attending routine clinic visits. Methods Participants provided self-administered rectal swabs and completed questionnaires regarding healthcare, travel and occupational exposures for the prior 12 months. Rectal samples were processed to identify Enterobacterales species, and susceptibility testing was performed. Results Among 82 participants, 110 Enterobacterales isolates were obtained. Non-susceptibility was common for penicillins, sulphonamides and first-generation cephalosporins. MDR-E was present in 20% of participants. HIV-related characteristics, including current or nadir CD4 cell count, viral suppression, or AIDS-defining clinical conditions, were not associated with MDR-E. Conclusions MDR-E colonization is common in this population of PWH. Further research evaluating risk factors for MDR-E in PWH may inform infection prevention approaches to better protect at-risk populations from these difficult-to-treat infections.
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Affiliation(s)
- Heather I Henderson
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura Ruegsegger
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kevin Alby
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jason R Smedberg
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bravada M Hill
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dylan Brown
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David A Wohl
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David Van Duin
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Mukapa N, Mataruse A, Ngwende GW, Robertson V. Incidence, risk factors and microbiological aetiology of urinary tract infections in admitted stroke patients at a teaching hospital in Zimbabwe: A prospective cohort study. Infect Prev Pract 2022; 4:100210. [PMID: 35308560 PMCID: PMC8924623 DOI: 10.1016/j.infpip.2022.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background and purpose The occurrence of urinary tract infections (UTIs) after stroke is a well recognised complication. The aim of this study was to determine the incidence of UTIs in stroke patients admitted at a teaching hospital in Zimbabwe. Methods A prospective cohort study was conducted in stroke patients admitted within 7 days from onset of stroke. Patients were followed up throughout the admission period and those with symptomatic UTI were identified. Urine samples for analysis were collected and causative bacterial organisms were identified with their antibiotic susceptibility patterns analysed. Results A total of 145 stroke patients were followed up during their in-patient care. 28 patients (19.3%) developed a urinary tract infection, 45 patients (31%) had asymptomatic bacteriuria and 72 patients (49.7%) had no bacteriuria. The median time from admission to UTI occurrence post stroke was 5 (IQR 4–7) days. Severe stroke (NIHSS score 16–42) was an independent risk factor for UTI development with an odds ratio (OR) 5.15 (1.68–15.75) p<0.001.The commonest bacterial causative organisms cultured were Escherichia coli (27.6%) ; Klebsiella species (21.1%) and Enterococcus faecalis (19.7%). Twenty nine percent of the cultured Gram negative bacteria were extended-spectrum beta-lactamase (ESBL) producers. Conclusions UTIs are common in admitted stroke patients and a significant percentage of causative organisms are multi-drug resistant. UTI occurrence is more common in patients with severe stroke and is associated with increased hospital stay. These observations highlight the need for robust infection prevention and control strategies to curb this common post-stroke complication.
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Affiliation(s)
- Nickson Mukapa
- Department of Primary Health Care Sciences, Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Zimbabwe
- Corresponding author. Address: Department of Primary Health Care Sciences, Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe.
| | - Andrew Mataruse
- Department of Primary Health Care Sciences, Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Zimbabwe
| | - Gift Wilson Ngwende
- Department of Primary Health Care Sciences, Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Zimbabwe
| | - Valerie Robertson
- Department of Laboratory Diagnostic and Investigative Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Zimbabwe
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Li W, Liu Q. The Effect of Needle Tract Nursing Methods to Reduce Needle Tract Infection in Patients with Indwelling Percutaneous Bone Puncture. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5812562. [PMID: 34630989 PMCID: PMC8500755 DOI: 10.1155/2021/5812562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/28/2021] [Indexed: 11/18/2022]
Abstract
Percutaneous bone piercing needles are used in orthopedics, which play the role of needle fixation. Needle tract infection is a common complication during the use of percutaneous bone needles. How to prevent needle tract infection is an important topic, so it is necessary to explore better needle tract care methods during percutaneous bone needle indwelling, to provide a basis for clinical work. Based on this, the purpose of this article is to study the effects of needle tract nursing methods for patients with indwelling percutaneous bone puncture needle infections. In this article, through an overview of percutaneous bone needle tract infection, on this basis, a detailed analysis of its occurrence, causes, and main influencing factors are carried out. Experimental studies have shown that the incidence of needle tract infections is 23.64%, mainly mild needle tract infections. Mild needle tract infections account for 84.62% of all needle tract infections, of which grade 1 needle tract infections account for 50.00 of mild needle tract infections. Severe needle tract infections accounted for 15.38% of all needle tract infections. All severe needle tract infections were grade 4 needle tract infections. No patients had bone infections or osteomyelitis.
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Affiliation(s)
- Weichao Li
- The Seventh Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Infectious Diseases Department, Sun Yat-sen University, Guangzhou, China
| | - Qiongshan Liu
- The Seventh Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- The Office of Organ Donation and Transplant, Sun Yat-sen University, Guangzhou, China
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