Prevalence of cryptococcal antigenemia, bacterial Bloodstream infections, antimicrobial susceptibility Pattern of bacterial isolates, and associated factors Among hiv-infected patients at jimma university Comprehensive specialized hospital

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.