1National Health Laboratory Service - Pelonomi Hospital, Bloemfontein, South Africa
2Faculty of Health and Environmental Sciences, Center for Quality of Health & Living, Central University of Technology-Free State, South Africa
*Corresponding Author: P.M Makhoahle, Faculty of Health and Environmental Sciences, Center for Quality of Health & Living, Central University of Technology-Free State, South Africa. Email: pmakhoahle@cut.ac.za
Received: 19th Oct, 2025; Revised: 15th Dec, 2025; Accepted: 16th Jan, 2026; Available Online: 15th Feb, 2026
Background: Globally, studies has shown that microorganism infections are responsible for high rate of morbidity and mortality among immune-compromised patients. Such an increase is being observed in Sub-Saharan countries, particularly in Intensive-Care Units. Such an increase is be attributed by different factors such as age, immune status, pre-existing disease and diagnostic or therapeutic interventions. The deadly twin diseases namely HIV and TB made chronic patients more prone and susceptible to other opportunistic microorganisms.
Objectives: The study aimed to determine the prevalence microbial population in immunocompromised patients hospitalized in the different hospitals living with TB or/and HIV positive. Secondly to identify factors posing risks in the target study population, and to determine the antimicrobial prevalence rate in the different hospital wards.
Methods: This was ethically approved a retrospective, cross-sectional study using data collected over a period of five years with inclusion criteria being that patient should have TB or / and HIV at the time of hospitalization
Results: Forty-eight thousand five hundred ninety seven met the inclusion criteria in the study with majority from the Frances Baard District Municipality in Kimberley (NC) (58.4%), and Mangaung Metropolitan Municipality (FS) accounted for 37.9%. Most patients (58.4%) where treated at RM Sobukwe hospital, followed by 20.9% patients treated at the Universitas Academic hospital. The highest age (28-37) group accounted for 27.1%, and second most been 38-47 years at 26.4%, the least population (0.8%) aged (78-87) years. Fewer patients were admitted to hospitals age (58 years and above) and majority were female (49.9%) with 0.7% of the patients' gender was unknown. Majority of patients (89.4%) tested negatively with 6.8% patients tested positively for TB across all six hospitals, while 1.6% and 1.8% patients' TB results were unknown or not tested, respectively. The highest number of patients testing positive for TB was recorded at the National Hospital (9.7%), Bongani Hospital (8.3%). RM Sobukwe Provincial hospital reported n=2,226 (7.8%) TB-positive cases, Mofumahadi Manapo Mopeli hospital (7.1%) TB-positive cases, Pelonomi hospital (6.3%) positive cases, and Universitas Academic hospital h (3.6%) TB-positive cases. Majority patients' group (70.9%) were not HIV-1/2 rapid screen tested, of those tested 1.2% were found to be HIV positive while 4.2% tested negative. The results showed that majority (70.9%) were not screened, while 4.3% were positive a significant 24.4% were negative. The results showed that only 0.6% of the patients encountered unclear HIV outcomes. The data show that fewer (7.9%) patients test showed undetectable HIV (<50 copies/mL) viral load, an indication of possible adhered to ART treatment. Almost a same number (6.9%) of patients exhibited a low HIV (50-10,000 copies/mL) viral load, and (6.8%) showed a similar trend of high HIV viral load >100,000 copies/mL. A significant 74.9% of patients were not tests HIV. The data showed that most patients (68.9%) had no CD4 ARV results, an indication of less monitored immune systems. Weak immune system (<350 cells/mm³) was found in (23.4%) patients, suggestion of less-adherence with ART treatment. 3.6% of the patients experienced mild immunosuppression (350–499 cells/mm³), while 4.2% had a robust immune system, indicating adherence to ART treatment.
The study also evaluated the prevalence testing method for all the specimens submitted to the laboratory for microbes and antimicrobial testing. Automated culture was the method mostly used in the laboratory, and it was reported to be at the rate of 42.8%, followed by culture urine (25.4%), culture pus (23.3%). Culture catheter tip was the least frequently used test method, displaying a rate of 8.5%. 48 597 specimens were reported to have been tested in the laboratory. In the study, the type of specimen collected from patients and sent to the laboratory for testing was also analysed. 48 597 specimens were collected. Blood culture (38.4%) was the most frequently collected specimen as the patients might have been suspected of having a bloodstream infection and urine was the second-most frequently collected specimen (16.5%), as the patients might have been suspected for having UTI. The study observed a prevalence of microorganisms in hospitals that are located in urban facilities, compared to facilities located in rural areas and the most prevalent bacterial species been Gram negative accounting for 40.1% namely (Escherichia Coli (16.9%), Klebsiella pneumoniae subsp pneumonia (9.4%); Proteus mirabilis (4%); Acinetobacter baumannii (3.7%); Pseudomonas aeroginosa (3.2%), Enterobacter Cloacae subsp. Cloacae (2.9%), and gram positive organisms accounted for 35.6% (Staphylococcus aureus (14.5%), Coagulase Negative Staphylococcus (11.9%), Staphylococcus epidermidis (5.2%), Streptococcus pneumoniae (4%). Gentamicin was found to have resistance in gram-positive bacteria Enterococcus faecalis at 31.8% and Enterococcus faecium at 69.8%. The study also showed that Streptococcus pneumoniae had high sensitivity (50.7%) to ceftriaxone antibiotic. The results showed that both groups gram-negative and gram-positive bacteria were resistant to trimethoprim-sulfamethoxazole antibiotic on 68.3% and 42.2%, respectively.
Discussion: The study proved that the ward type where patients were admitted to plays a huge risk factor in antibiotic treatment. Most patients who were admitted to medical wards showed a very high prevalence of antimicrobial resistance. Resistance was observed in all the antibiotics. The same trend was observed in both ICUs, in the A6 Intensive Care Unit and Multidisciplinary unit. Nitrofurantoin antibiotic displayed high sensitivity in most wards.
Conclusion: Even though minority of data was screened its worth reporting that of those tested a high HIV viral load and low CD4 count, which show non-compliance with ART. The majority of male patients had a detectable viral load and a low CD4 count, which is a risk factor for acquiring microbial infections. There was a high prevalence of antimicrobial resistance from different wards in the study and trimethoprim-sulfamethoxazole antibiotic showed high resistance to both gram-negative and gram-positive bacteria, 68.3% and 42.2%, respectively.
Keywords: Microbial infections, Multidrug-resistant organisms, Antimicrobial resistance.
How to cite this article: Mkhatshwa TK, Makhoahle PM.., Immune Suppression and Antimicrobial Resistance in Hospitalised HIV Patients: Evidence from Free State and Northern Cape Hospitals...Int J Drug Deliv Technol. 2026; 16(2): 196-222; DOI: 10.25258/ijddt.16.2.25
Source of support: Nil.
Conflict of interest: None