Carriage of extended-spectrum b-lactamase-producing enterobacterales (ESBL-E) was found to be more common among men who have sex with men (MSM) on HIV pre-exposure prophylaxis (PrEP) and MSM with HIV infection. These findings were published in Clinical Infectious Diseases.

The Bactériers MultiRésistantes-Infectious sexuellement transmissibles (BMR-IST) study was conducted at a single center at the Sorbonne Université Saint-Antoine Hospital in France. Study participants (N=2157) were either positive or negative for HIV infection and were enrolled between 2018 and 2019. Carriage of ESBL-E was evaluated at baseline and at 6 months. Risk for infection and carriage were evaluated on the basis of patient demographics and sexual activity.

Among participants included in the study, 251 were MSM on PrEP, 487 were MSM and negative for HIV infection, 500 were MSM and positive for infection, 439 were men who have sex with women (MSW) and negative for infection, and 480 were women who have sex with men and negative for infection. The cohorts of MSW and WSM skewed younger (median age range, 25-46 years) and cohorts differed in regard to sexual activity within the past 6 months and previous diagnosis with a sexually transmitted infection (all P <.001).


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For EBSL-E-specific risk factors, cohort differences were observed for pet ownership (P <.001), use of antibiotics within the past 6 months (P <.001), hospitalization within the past 12 months (P =.001), recent travel abroad (P =.001), having a vegetarian or vegan diet (P =.005), and communal living (P =.04).

The rate of ESBL-E carriage was most increased among HIV-negative MSM on PrEP (16.3%), followed by HIV-positive MSM (12.2%), HIV-negative MSW (10.0%), HIV-negative MSM (9.7%), and HIV-negative WSM (6.9%). Compared with women, the risk for ESBL-E was statistically significantly increased among both HIV-negative MSM on PrEP (adjusted odds ratio [aOR], 1.94; 95% CI, 1.09-3.44) and HIV-positive MSM (aOR, 1.75; 95% CI, 1.03-2.97).

The number of casual sexual partners in the previous 6 months was most decreased among women (median, 2; IQR, 1-4) and most increased among MSM on PrEP (median, 15; IQR, 6-30). After adjustment for patient age, geographic location, travel abroad, and antibiotic use within the past 6 months, the researchers found a significant association between an increased number of sexual partners and prevalence of ESBL-E carriage (P =.004).

In a bacteriologic analysis, significant differences between the cohorts were observed for ESBL sequence type (P =.001), ESBL genes (P =.004), and presence of the quinolone resistance gene parE (P =.02). In regard to ESBL genes, SHV-12 was exclusively observed among the MSM cohorts (P <.001).

Among participants who were carriers of ESBL-E at baseline, 103 (46%) returned for the 6-month follow-up, of whom 26 (25%) remained positive for ESBL-E.

This study was limited by its reliance on self-reported sexual practices.

This study found that the rate of ESBL-E carriage was most increased among MSM on PrEP and HIV-positive MSM. In general, the prevalence of ESBL-E carriage scaled with the number of sexual partners among all patient cohorts. The researchers concluded, “…more research is warranted to understand the clinical consequences of ESBL-E carriage and how it can be [decreased] in these populations.”

Disclosure: Multiple authors declared affiliations with industry. Please see the original reference for a full list of disclosures.

Reference

Surgers L, Chiarabini T, Royer G, et al. Evidence of sexual transmission of extended-spectrum β-lactamase-producing Enterobacterales: a cross-sectional and prospective study. Clin Infect Dis. 2022;ciac218. doi:10.1093/cid/ciac218