Submitted: 20 Oct 2023
Revision: 27 Nov 2023
Accepted: 14 Dec 2023
ePublished: 29 Dec 2023
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Avicenna J Clin Microbiol Infect. 2023;10(4): 166-172.
doi: 10.34172/ajcmi.3505
  Abstract View: 447
  PDF Download: 322

Review Article

Carbapenem Resistance among HIV-Infected Patients: A Scoping Review

Kylie Divashnee Konar 1 ORCID logo, Rushern Ruvashin Chetty 2* ORCID logo, Selina Konar 3 ORCID logo, Somasundram Pillay 4 ORCID logo

1 Department of Internal Medicine, Frere Hospital, East London, South Africa
2 Medical Doctor in Private Practice
3 Department of Microbiology, Inkosi Albert Luthuli Hospital, Durban, South Africa
4 Department of Internal Medicine, King Edward Hospital, Durban AND Department of Internal Medicine, University of Kwa-Zulu Natal, Durban, South Africa
*Corresponding Author: Rushern Ruvashin Chetty, Email: rushern.r.chetty@gmail.com, Email: Rushern.r.chetty@gmail.com


Background: Antibiotic resistance is an escalating global health concern, with carbapenems, potent last-line antibiotics, facing increasing resistance and potentially dire consequences. This scoping review sought to consolidate data on carbapenem resistance in human immunodeficiency virus (HIV)-infected patient cohorts as the intricate relationship between HIV and antibiotic resistance remains inadequately understood.

Methods: We employed a scoping review methodology and conducted a comprehensive search across Google Scholar, Scopus, Cochrane, and PubMed, utilizing specific search terms related to carbapenem resistance and HIV. We extracted and analyzed data, encompassing study design, geographic location, number of HIV-infected participants, CD4 cell counts, specimen types, cultured organisms, carbapenem susceptibility, and comparisons between HIV-infected and uninfected cohorts.

Results: This review encompassed 15 studies, involving 2365 HIV-infected participants, primarily employing cross-sectional designs, with nine studies conducted in African countries. The most frequently analyzed specimens included urine, stool, and sputum, with Escherichia coli emerging as the most frequently cultured organism. Commonly used carbapenem drugs included imipenem, meropenem, and ertapenem, with varying susceptibility patterns. Imipenem and meropenem exhibited sensitivities exceeding 80%, except for one study with Pseudomonas aeruginosa, which demonstrated 73% sensitivity. Ertapenem displayed fluctuating sensitivities ranging from 58% to 100% for different bacterial organisms. Only one study reported the colonization of carbapenem-resistant Enterobacterales (CRE) in HIV-infected patients, with HIV status not significantly influencing CRE carriage. When comparing HIV-infected and uninfected cohorts, four studies found no substantial impact of HIV status on carbapenem resistance.

Conclusion: In the context of the HIV burden and opportunistic infections, carbapenem resistance demonstrated relatively consistent patterns across most studies comparing HIV-infected and uninfected cohorts. However, the presence of CRE among HIV-infected individuals raises concerns regarding nosocomial infections. The limited reporting of CD4 counts in the included studies necessitates further exploration of potential associations with immune status. E. coli, frequently cultured in these studies, exhibited varying resistance patterns, and the impact of HIV on these patterns remains uncertain. Carbapenem susceptibility displayed variability among different organisms, underscoring the nuanced nature of resistance. As such, this scoping review serves as a foundation for comprehending carbapenem resistance in HIV-infected populations but underscores the necessity for more comprehensive research in this field.

Please cite this article as follows: Konar KD, Chetty RR, Konar S, Pillay S. Carbapenem resistance among HIV-infected patients: a scoping review. Avicenna J Clin Microbiol Infect. 2023; 10(4):166-172. doi:10.34172/ajcmi.3505
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