Abstract:
Background: Cryptococcal antigenemia and bacterial bloodstream infections (BSIs) are
significant causes of morbidity and mortality among HIV patients, particularly in sub-Saharan
Africa, where limited diagnostics and advanced immunosuppression exacerbate outcomes. In
Ethiopia, cryptococcal meningitis (CM) accounts for a substantial proportion of HIV-related
deaths, with varying prevalence rates reported across regions. However, localized data for Jimma
remains scarce. This study aimed to determine the prevalence of cryptococcal antigenemia,
bacterial BSIs, antimicrobial resistance (AMR) patterns, and associated factors among HIV
patients at Jimma University Comprehensive Specialized Hospital (JUCSH).
Methods: A cross-sectional study was conducted from May 2024 to March 2025, involving 138
HIV patients with CD4 counts ≤200 cells/mm³. Cryptococcal antigenemia was detected using a
lateral flow assay (LFA), while bacterial BSIs were identified through blood culture and
biochemical tests. Antimicrobial susceptibility testing was performed using the Kirby-Bauer
method. Logistic regression was used to identify risk factors.
Results: The results showed a CrAg positivity rate of 6.5% (9/138), with 5 out of 9 cases culture
positive. Bacterial BSIs were detected in 12.3% (17/138) of participants, with Gram-negative
isolates predominating at 58.8% (10/17), including Klebsiella pneumoniae and Escherichia coli.
Risk factors for cryptococcal antigenemia included second-line ART (AOR: 18.1; 95% CI: 2.2
148.5), opportunistic infections (AOR: 10.6; 95% CI: 1.2–90.5), and prior hospitalization (AOR:
17.1; 95% CI: 1.8–171.6). While bacterial BSIs, low CD4 counts (AOR: 4.3; 95% CI: 1.1–16.6)
and clinical symptoms like fever (AOR: 24.2; 95% CI: 5.8–101.1) were significant predictors.
Multidrug resistance (MDR) was observed in 91.7% of Gram-negative isolates.
Conclusion: The study highlighted a significant prevalence of CrAg and BSIs among advanced
HIV patients, with high MDR rates. Enhanced surveillance, targeted interventions, and
antimicrobial stewardship were urgently needed to mitigate these risks.
