title: Elevated prevalence of multidrug-resistant gram-negative organisms in HIV positive men.
abstract: Routes of transmission of multidrug-resistant gram-negative organisms (MDRGN) are not completely understood. Since sexual transmission of MDRGN might represent a potential mode that has not been noticed so far, this study evaluated transmission of MDRGN in HIV positive men.
  
  
  
  Between November 2014 and March 2016, we retrospectively investigated the MDRGN prevalence in rectal swabs of n = 109 males tested positive for HIV (HP). These findings were compared to the MDRGN prevalence in n = 109 rectal swabs in age-matched males tested negative for HIV (HN) within the same period. According to the infection control protocol of University Hospital Frankfurt, Germany (UHF), patients admitted to intensive/intermediate care units have to be screened for MDRGN on day of admittance. Patients without HIV testing or MDRGN screening were excluded.
  
  
  
  MDRGN prevalence in rectal swabs was significantly higher (p = 0.002) in male HP (23.9%; 95% confidence interval 16.2-32.9%) than in age-matched male HN (8.3%; 3.8-15.1%). In total, 35 MDRGN species were detected. The most frequent MDRGN species was Escherichia coli with resistance due to ESBL expression and additional resistance to fluoroquinolones with n = 25/35 (71.4%; 53.7-85.4%). Thereof, n = 19/26 (73.1%; 52.2-88.4%) were detected in HP and n = 6/9 (66.7%; 29.9-92.5%) in HN, respectively.
  
  
  
  Prevalence of MDRGN is significantly higher in male HIV positive than in male HIV negative individuals. This might indicate sexual transmission of MDRGN within the male HIV positive population. As treatment options in case of MRGN infections are limited, prevention of MDRGN transmission is strongly emphasized.
authors.affiliation: Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul-Ehrlich-Str. 40, 60596, Frankfurt am Main, Germany. claudia.reinheimer@kgu.de.|University Center for Infectious Diseases, University Hospital Frankfurt am Main, Frankfurt am Main, Germany. claudia.reinheimer@kgu.de.
authors.forename: Claudia
authors.initials: C
authors.lastname: Reinheimer
authors.affiliation: Institute for Medical Virology, University Hospital Frankfurt, Frankfurt am Main, Germany.|Present address: Max von Pettenkofer-Institute for Hygiene and Clinical Microbiology, Virology, Ludwig Maximilians-University, Munich, Germany.
authors.forename: Oliver T
authors.initials: OT
authors.lastname: Keppler
authors.affiliation: University Center for Infectious Diseases, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.|Department for Internal Medicine II/Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Stephan
authors.affiliation: Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul-Ehrlich-Str. 40, 60596, Frankfurt am Main, Germany.|University Center for Infectious Diseases, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Wichelhaus
authors.affiliation: University Center for Infectious Diseases, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.|Institute for Medical Virology, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Imke
authors.initials: I
authors.lastname: Friedrichs
authors.affiliation: Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul-Ehrlich-Str. 40, 60596, Frankfurt am Main, Germany.|University Center for Infectious Diseases, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.|Institute for Medical Virology, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Volkhard A J
authors.initials: VA
authors.lastname: Kempf
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects; D005858:Germany / Q000453:epidemiology; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D017053:Infection Control; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012007:Rectum / Q000382:microbiology; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: Emerging pathogens; Epidemiology; Infection control; Multidrug-resistant gram-negative bacteria