Bacteriological and prognostic profile of non-tuberculous bacterial pneumonia in HIV patients in Mali.

Abstract

Introduction: Non-tuberculous respiratory bacterial infections are frequent, especially in HIV patients, but microbiological diagnosis remains difficult. The objective was to identify the bacteria isolated in the sputum of HIV patients in the Infectious Disease Department of the Point "G" University teaching Hospital, in Mali.Methodology: This is an analytical cross-sectional study from June 2017 to July 2019. Patients infected with HIV, presenting an infectious pneumopathy for whom the culture of sputum sent to the Laboratory came back positive were included. Standard methods of isolation and identification of bacteria were used. Results: A total of 445 HIV patients were hospitalized, 222 of whom presented with infectious pneumonitis (49.9%). Sputum was analyzed in 174 patients (78.4%) with isolation of 59 non-tuberculous bacterial agents (33.9%). Enterobacteriaceae (62.7%), non-fermenting Gram-negative bacilli (20.3%) and Gram-positive Cocci (17.0%) were the three groups of pathogens that were highlighted. K. pneumoniae (28.8%), E. coli (13.6%), E. cloacae (13.6%), A. baumannii (11.9%), P. aeruginosa (6.8%) and S. pneumoniae (6.8%) were the most isolated strains in sputum. Coinfection with Mycobacterium tuberculosis was 27.1% (n = 16). No anti-tuberculosis drug resistant strains were detected. On the other hand, 17 multidrug-resistant strains (28.8%) namely 14 ESBL, two IRAB and one MRSA were found among the other germs. The median time to diagnosis was 7 days [IIQ: 3 days and 15 days]. The germs were isolated from 57 patients whose mean age was 43.7 ± 11.4 years (19 and 68 years). The sex ratio was 1.85. The history of tuberculosis and the notion of smoking were found in 7% and 15.8% of cases, respectively. The mean hospital stay was 24.4 ± 14.1 days (5 and 68 days). It was 33.2 ± 11.8 days in patients co-infected with tuberculosis and 22.6 ± 13.7 days in monoinfected patients (p = 0.008). Hospital mortality was 22.8% (n = 13). Conclusion: Non-tuberculous pneumonia is common in HIV patients. The microorganisms found are dominated by enterobacteria, which are sometimes multiresistant. Co-infection with tuberculosis is frequent, hence the need for their systematic search for pulmonary signs in this area.