PMID- 28513417
OWN - NLM
STAT- MEDLINE
DCOM- 20170614
LR  - 20191210
IS  - 1473-5644 (Electronic)
IS  - 0022-2615 (Print)
IS  - 0022-2615 (Linking)
VI  - 66
IP  - 5
DP  - 2017 May
TI  - Carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae in 
      HIV-infected children in Zimbabwe.
PG  - 609-615
LID - 10.1099/jmm.0.000474 [doi]
AB  - BACKGROUND: Antimicrobial resistance is an emerging global health issue. Data on 
      the epidemiology of multidrug-resistant organisms are scarce for Africa, 
      especially in HIV-infected individuals who often have frequent contact with 
      healthcare. We investigated the prevalence of extended-spectrum 
      beta-lactamase-producing Enterobacteriaceae (ESBL-E) carriage in stool among 
      HIV-infected children attending an HIV outpatient department in Harare, Zimbabwe. 
      METHODS: We recruited children who were stable on antiretroviral therapy (ART) 
      attending a HIV clinic from August 2014 to June 2015. Information was collected 
      on antibiotic use and hospitalization. Stool was tested for ESBL-E through 
      combination disc diffusion. API20E identification and antimicrobial 
      susceptibility was performed on the positive samples followed by whole genome 
      sequencing. RESULTS: Stool was collected from 175/202 (86.6 %) children. Median 
      age was 11 [inter-quartile range (IQR) 9-12] years. Median time on ART was 4.6 
      years (IQR 2.4-6.4). ESBL-Es were found in 24/175 samples (13.7 %); 50 % of all 
      ESBL-Es were resistant to amoxicillin-clavulanate, 100 % to co-trimoxazole, 
      45.8 % to chloramphenicol, 91.6 % to ceftriaxone, 20.8 % to gentamicin and 62.5 % 
      to ciprofloxacin. ESBL-Es variously encoded CTX-M, OXA, TEM and SHV enzymes. The 
      odds of ESBL-E carriage were 8.5 times (95 % CI 2.2-32.3) higher in those on ART 
      for less than one year (versus longer) and 8.5 times (95 % CI 1.1-32.3) higher in 
      those recently hospitalized for a chest infection. CONCLUSION: We found a 13.7 % 
      prevalence of ESBL-E carriage in a population where ESBL-E carriage has not been 
      described previously. Antimicrobial resistance (AMR) in Africa merits further 
      study, particularly given the high HIV prevalence and limited diagnostic and 
      therapeutic options available.
FAU - Wilmore, S M S
AU  - Wilmore SMS
AD  - Royal Free Hospital NHS Trust, London, UK.
AD  - London School of Hygiene and Tropical Medicine, London, UK.
AD  - UCL Centre for Clinical Microbiology, University College London, London, UK.
FAU - Kranzer, K
AU  - Kranzer K
AD  - London School of Hygiene and Tropical Medicine, London, UK.
AD  - National German Mycobacterium Reference, Borstel, Germany.
FAU - Williams, A
AU  - Williams A
AD  - Royal Free Hospital NHS Trust, London, UK.
FAU - Makamure, B
AU  - Makamure B
AD  - Biomedical Research and Training Institute, Harare, Zimbabwe.
FAU - Nhidza, A F
AU  - Nhidza AF
AD  - Biomedical Research and Training Institute, Harare, Zimbabwe.
FAU - Mayini, J
AU  - Mayini J
AD  - Biomedical Research and Training Institute, Harare, Zimbabwe.
FAU - Bandason, T
AU  - Bandason T
AD  - Biomedical Research and Training Institute, Harare, Zimbabwe.
FAU - Metcalfe, J
AU  - Metcalfe J
AD  - University of California, San Francisco, USA.
FAU - Nicol, M P
AU  - Nicol MP
AD  - University of Cape Town, National Health Laboratory Service, Cape Town, South 
      Africa.
FAU - Balakrishnan, I
AU  - Balakrishnan I
AD  - Royal Free Hospital NHS Trust, London, UK.
FAU - Ellington, M J
AU  - Ellington MJ
AD  - Public Health England, London, UK.
FAU - Woodford, N
AU  - Woodford N
AD  - Public Health England, London, UK.
FAU - Hopkins, S
AU  - Hopkins S
AD  - Royal Free Hospital NHS Trust, London, UK.
AD  - Public Health England, London, UK.
FAU - McHugh, T D
AU  - McHugh TD
AD  - UCL Centre for Clinical Microbiology, University College London, London, UK.
FAU - Ferrand, R A
AU  - Ferrand RA
AD  - London School of Hygiene and Tropical Medicine, London, UK.
AD  - Biomedical Research and Training Institute, Harare, Zimbabwe.
LA  - eng
GR  - Wellcome Trust/United Kingdom
PT  - Journal Article
DEP - 20170518
PL  - England
TA  - J Med Microbiol
JT  - Journal of medical microbiology
JID - 0224131
RN  - 0 (Anti-Bacterial Agents)
RN  - 5E8K9I0O4U (Ciprofloxacin)
RN  - EC 3.5.2.6 (beta-Lactamases)
SB  - IM
MH  - Adolescent
MH  - Ambulatory Care
MH  - Anti-Bacterial Agents
MH  - Antiretroviral Therapy, Highly Active
MH  - CD4 Lymphocyte Count
MH  - Carrier State/*epidemiology/microbiology
MH  - Child
MH  - Ciprofloxacin/pharmacology
MH  - Enterobacteriaceae/drug effects/*enzymology/genetics/*isolation & purification
MH  - Enterobacteriaceae Infections/*complications/*epidemiology/microbiology
MH  - Feces/microbiology
MH  - Female
MH  - HIV Infections/*complications/drug therapy/epidemiology/virology
MH  - Humans
MH  - Male
MH  - Microbial Sensitivity Tests
MH  - Prevalence
MH  - Zimbabwe/epidemiology
MH  - beta-Lactamases/*biosynthesis/genetics
PMC - PMC5817228
COIS- The authors declare that there are no conflicts of interest.
EDAT- 2017/05/18 06:00
MHDA- 2017/06/15 06:00
PMCR- 2017/05/18
CRDT- 2017/05/18 06:00
PHST- 2017/05/18 06:00 [pubmed]
PHST- 2017/06/15 06:00 [medline]
PHST- 2017/05/18 06:00 [entrez]
PHST- 2017/05/18 00:00 [pmc-release]
AID - 000474 [pii]
AID - 10.1099/jmm.0.000474 [doi]
PST - ppublish
SO  - J Med Microbiol. 2017 May;66(5):609-615. doi: 10.1099/jmm.0.000474. Epub 2017 May 
      18.