Vancomycin-resistant Enterococci colonization among HIV-positive individuals at Goba Referral Hospital: prevalence and associated factors

Enterococci are commensal members of the gastrointestinal microbiota, but antimicrobial resistant strains including vancomycin resistant Enterococci can cause difficult to treat infections. Antibiotic exposure and impaired host defenses may disrupt the gut microbiota, facilitating colonization by vancomycin-resistant Enterococci. To assess the prevalence of Enterococcus colonization and Vancomycin-Resistant Enterococcus , describe antimicrobial susceptibility patterns, and determine factors associated with Vancomycin-resistant Enterococci colonization among individuals living with HIV at Madda Walabu University Goba Referral Hospital, Ethiopia. A cross-sectional study design was employed from June 1st to August 30th 2025, using systematic random sampling techniques to select 178 HIV positive patients above 18 years old. Socio demographic and clinical information were collected using pre-tested questionnaires and medical charts. Fecal samples (5–10 g) were cultured on Bile Esculin Azide Agar at 37 °C for 24 h. Enterococcus species were identified by gram staining, catalase test and growth in Brain Heart Infusion broth with 6.5% NaCl and 45 °C. Antibiogram was done using disk diffusion Kirby Bauer technique according to Clinical Laboratory Standard Institute guidelines. Statistical analysis was carried out using IBM SPSS Version 25.0. Associations were assessed using Fishers exact test for small number of cells with significant associations set at P < 0.05. Gastrointestinal Enterococcus species colonization was detected in 104 out of 178 study participants, representing cohort carriage prevalence of 58.4% (104/178; CI:51.1%-65. 7%).Among the 104 recovered Enterococcus isolates,12 were Vancomycin-resistant Enterococci 11.5% (12/104;95% CI:5.8%-18.3%) and an overall cohort of Vancomycin-resistant Enterococci prevalence of 6.7%(12/178). Multi-drug resistance was observed in 47.1% (49/104) of all Enterococcus isolates and 100% (12/12) of Vancomycin-resistant Enterococci isolates. In Bivariable Fishers exact test, four factors were significantly associated with Vancomycin-resistant Enterococci colonization ( p < 0.05): history of catheterization (50.0% vs. 8.3%, p = 0.006), male sex (23.1% vs. 4.6%, p = 0.009), CD4 count < 350 cells/µL (23.5% vs. 5.7%, p = 0.018) and substance or drug use (42.9% vs. 9.3%, p = 0.032). Vancomycin-resistant Enterococcus was found among participants with Enterococcus isolates. The small number of participants positive for Vancomycin-resistant Enterococci limits the precision of estimates and assessment of associated factors. The results support the need for strengthening local antimicrobial resistance surveillance and infection prevention practices, while larger studies with confirmatory susceptibility testing and molecular characterization are warranted. Not applicable.