Severe Bacterial Non-AIDS Infections in Persons With Human Immunodeficiency Virus: The Epidemiology and Evolution of Antibiotic Resistance Over an 18-Year Period (2000-2017) in the ANRS CO3 AquiVih-Nouvelle-Aquitaine Cohort

Background Severe non-AIDS bacterial infections (SBIs) are among the leading causes of hospital admissions among persons with human immunodeficiency virus (PWH) in regions with high antiretroviral therapy coverage. Methods This large prospective cohort study of PWH examined the types of infections, bacterial documentation, and evolution of antibiotic resistance among PWH hospitalized with SBIs over an 18-year period. Results Between 2000 and 2017, 459 PWH had at least 1 SBI with bacterial documentation. Among the 847 SBIs, there were 280 cases of bacteremia, 269 cases of pneumonia, and 240 urinary tract infections. The 1025 isolated bacteria included Enterobacteriaceae (n = 394; mainly Escherichia coli), Staphylococcus aureus (n = 153), and Streptococcus pneumoniae (n = 82). The proportion of S. pneumoniae as the causative agent in pneumonia and bacteremia decreased sharply over time, from 34% to 8% and from 21% to 3%, respectively. The overall antibiotic resistance of S. aureus and S. pneumoniae decreased progressively but it increased for Enterobacteriaceae (from 24% to 48% for amoxicillin-clavulanate, from 4% to 18% for cefotaxime, and from 5% to 27% for ciprofloxacin). Cotrimoxazole prophylaxis was associated with higher nonsusceptibility of S. pneumoniae to amoxicillin and erythromycin, higher nonsusceptibility of Enterobacteriaceae to beta-lactams and fluoroquinolones, and a higher risk of extended-spectrum beta-lactamase-producing Enterobacteriaceae. Conclusions The bacterial resistance pattern among PWH between 2014 and 2017 was broadly similar to that in the general population, with the exception of a higher resistance profile of Enterobacteriaceae to fluoroquinolones. The use of cotrimoxazole as prophylaxis was associated with an increased risk of antibiotic resistance. The proportion of Streptococcus pneumoniae infections in HIV patients decreased over time, as did resistance of Staphylococcus aureus and Streptococcus pneumoniae. Resistance of Enterobacteriaceae increased. The use of cotrimoxazole as prophylaxis was associated with an increased risk of antibiotic resistance.

Automated summary

This large prospective cohort study examined the types of severe non-AIDS bacterial infections (SBIs) among people with HIV, as well as the bacterial documentation and antibiotic resistance patterns over an 18-year period. The study found that the proportion of Streptococcus pneumoniae infections in HIV patients decreased over time, as did resistance of Staphylococcus aureus and Streptococcus pneumoniae, while resistance of Enterobacteriaceae increased. The use of cotrimoxazole as prophylaxis was associated with an increased risk of antibiotic resistance.