Fluoroquinolone resistance higher among PLWH than general population in France, long-term study finds

Fluoroquinolone resistance is consistently higher among people living with HIV (PLWH) in France than in the general French population, an 18-year prospective study has found. That said, overall patterns of bacterial resistance were similar between the two groups—and both PLWH and the general French population experienced a drop over time in rates of antibiotic resistance with certain pathogens.

About This Study

“Severe bacterial non-AIDS infections in persons with HIV: the epidemiology and evolution of antibiotic resistance over an 18-year period (2000–2017) in the ANRS CO3 AquiVih-Nouvelle-Aquitaine cohort” was published online on Jan. 6, 2023, in Clinical Infectious Diseases. The lead author is Peggy Blanc, M.D., of Centre Hospitalier Universitaire de Bordeaux in Bordeaux, France.

Key Research Findings

Data came from 459 PLWH who were hospitalized for a total of 847 severe non-AIDS bacterial infections between 2000 and 2017 in southwestern France. The most common infections were bacteremia (280 cases), pneumonia (269 cases), and urinary tract infections (240 cases).

During the study period, the proportion of pneumonia and bacteremia caused by Streptococcus pneumoniae declined sharply—from 34% to 8% for pneumonia and from 21% to 3% for bacteremia.

Antimicrobial resistance was higher among PLWH with an AIDS diagnosis than those without such a diagnosis. Cotrimoxazole prophylaxis, which is used for severely immunocompromised people, was also associated with greater antibiotic resistance, including to common drugs such as amoxicillin.

In terms of specific demographic subgroups, men who have sex with men had a higher risk of nonsusceptibility to piperacillin-tazobactam and cefotaxime, as well as a higher risk of extended-spectrum β-lactamase infections.

Discussion Highlights and Implications for Practice

Researchers pointed out that participants diagnosed with AIDS likely had experienced more bacterial infections than people whose HIV infection had not progressed to an advanced stage; this required more antibiotic use, which triggered more resistance to such drugs, they theorized.

While it stands to reason that increased uptake of pneumococcal vaccination–recommended for all PLWH–would also play a role in pneumonia diagnoses, that vaccination status was not available in the current study, the authors noted.

The proportion of H. influenzae remained stable among PLWH during the study period. (In France, the flu vaccine is only recommended for older or pregnant people and those with certain conditions.) PLWH should be systematically vaccinated against H. influenzae, study authors suggested.

The authors also recommended that clinicians should be aware of the higher rates of fluoroquinolone resistance among French PLWH before prescribing any antibiotics.

By Barbara Jungwirth