PMID- 33632144
OWN - NLM
STAT- MEDLINE
DCOM- 20210319
LR  - 20230809
IS  - 1471-2334 (Electronic)
IS  - 1471-2334 (Linking)
VI  - 21
IP  - 1
DP  - 2021 Feb 25
TI  - Prevalence and antimicrobial resistance profiles of respiratory microbial flora 
      in African children with HIV-associated chronic lung disease.
PG  - 216
LID - 10.1186/s12879-021-05904-3 [doi]
LID - 216
AB  - BACKGROUND: HIV-associated chronic lung disease (CLD) is common among children 
      living with HIV (CLWH) in sub-Saharan Africa, including those on antiretroviral 
      therapy (ART). However, the pathogenesis of CLD and its possible association with 
      microbial determinants remain poorly understood. We investigated the prevalence, 
      and antibiotic susceptibility of Streptococcus pneumoniae (SP), Staphylococcus 
      aureus (SA), Haemophilus influenzae (HI), and Moraxella catarrhalis (MC) among 
      CLWH (established on ART) who had CLD (CLD+), or not (CLD-) in Zimbabwe and 
      Malawi. METHODS: Nasopharyngeal swabs (NP) and sputa were collected from CLD+ 
      CLWH (defined as forced-expiratory volume per second z-score < - 1 without 
      reversibility post-bronchodilation with salbutamol), at enrolment as part of a 
      randomised, placebo-controlled trial of azithromycin (BREATHE trial - NCT02426112 
      ), and from age- and sex-matched CLD- CLWH. Samples were cultured, and antibiotic 
      susceptibility testing was conducted using disk diffusion. Risk factors for 
      bacterial carriage were identified using questionnaires and analysed using 
      multivariate logistic regression. RESULTS: A total of 410 participants (336 CLD+, 
      74 CLD-) were enrolled (median age, 15 years [IQR = 13-18]). SP and MC carriage 
      in NP were higher in CLD+ than in CLD- children: 46% (154/336) vs. 26% (19/74), 
      p = 0.008; and 14% (49/336) vs. 3% (2/74), p = 0.012, respectively. SP isolates 
      from the NP of CLD+ children were more likely to be non-susceptible to penicillin 
      than those from CLD- children (36% [53/144] vs 11% [2/18], p = 0.036). 
      Methicillin-resistant SA was uncommon [4% (7/195)]. In multivariate analysis, key 
      factors associated with NP bacterial carriage included having CLD (SP: adjusted 
      odds ratio (aOR) 2 [95% CI 1.1-3.9]), younger age (SP: aOR 3.2 [1.8-5.8]), viral 
      load suppression (SP: aOR 0.6 [0.4-1.0], SA: 0.5 [0.3-0.9]), stunting (SP: aOR 
      1.6 [1.1-2.6]) and male sex (SA: aOR 1.7 [1.0-2.9]). Sputum bacterial carriage 
      was similar in both groups (50%) and was associated with Zimbabwean site (SP: aOR 
      3.1 [1.4-7.3], SA: 2.1 [1.1-4.2]), being on ART for a longer period (SP: aOR 0.3 
      [0.1-0.8]), and hot compared to rainy season (SP: aOR 2.3 [1.2-4.4]). 
      CONCLUSIONS: CLD+ CLWH were more likely to be colonised by MC and SP, including 
      penicillin-non-susceptible SP strains, than CLD- CLWH. The role of these bacteria 
      in CLD pathogenesis, including the risk of acute exacerbations, should be further 
      studied.
FAU - Abotsi, Regina E
AU  - Abotsi RE
AD  - Department of Molecular and Cell Biology & Institute of Infectious Diseases and 
      Molecular Medicine, University of Cape Town, Cape Town, South Africa. 
      abtreg001@myuct.ac.za.
AD  - Department of Pharmaceutical Microbiology, School of Pharmacy, University of 
      Health and Allied Sciences, Ho, Ghana. abtreg001@myuct.ac.za.
FAU - Nicol, Mark P
AU  - Nicol MP
AD  - Division of Infection and Immunity, School of Biomedical Sciences, Faculty of 
      Health and Medical Sciences, University of Western Australia, Perth, Australia.
FAU - McHugh, Grace
AU  - McHugh G
AD  - Biomedical Research and Training Institute, Harare, Zimbabwe.
FAU - Simms, Victoria
AU  - Simms V
AD  - MRC International Statistics & Epidemiology Group, London School of Hygiene and 
      Tropical Medicine, London, UK.
FAU - Rehman, Andrea M
AU  - Rehman AM
AD  - MRC International Statistics & Epidemiology Group, London School of Hygiene and 
      Tropical Medicine, London, UK.
FAU - Barthus, Charmaine
AU  - Barthus C
AD  - Division of Medical Microbiology, University of Cape Town, Cape Town, South 
      Africa.
FAU - Mbhele, Slindile
AU  - Mbhele S
AD  - Division of Medical Microbiology, University of Cape Town, Cape Town, South 
      Africa.
FAU - Moyo, Brewster W
AU  - Moyo BW
AD  - Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
FAU - Ngwira, Lucky G
AU  - Ngwira LG
AD  - Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
AD  - Liverpool School of Tropical Medicine, Liverpool, UK.
FAU - Mujuru, Hilda
AU  - Mujuru H
AD  - Department of Paediatrics, University of Zimbabwe, Harare, Zimbabwe.
FAU - Makamure, Beauty
AU  - Makamure B
AD  - Biomedical Research and Training Institute, Harare, Zimbabwe.
FAU - Mayini, Justin
AU  - Mayini J
AD  - Biomedical Research and Training Institute, Harare, Zimbabwe.
FAU - Odland, Jon O
AU  - Odland JO
AD  - Department of Community Medicine, University of Tromso, Tromso, Norway.
AD  - International Research Laboratory for Reproductive Ecotoxicology, The National 
      Research University Higher School of Economics, Moscow, Russia.
AD  - School of Health Systems and Public Health, Faculty of Health Sciences, 
      University of Pretoria, Pretoria, South Africa.
FAU - Ferrand, Rashida A
AU  - Ferrand RA
AD  - Biomedical Research and Training Institute, Harare, Zimbabwe.
AD  - Clinical Research Department, London School of Hygiene and Tropical Medicine, 
      London, UK.
FAU - Dube, Felix S
AU  - Dube FS
AD  - Department of Molecular and Cell Biology & Institute of Infectious Diseases and 
      Molecular Medicine, University of Cape Town, Cape Town, South Africa.
LA  - eng
GR  - 206316/Z/17/Z/WT_/Wellcome Trust/United Kingdom
GR  - MR/R010161/1/MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
DEP - 20210225
PL  - England
TA  - BMC Infect Dis
JT  - BMC infectious diseases
JID - 100968551
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Anti-Retroviral Agents)
SB  - IM
MH  - Adolescent
MH  - Anti-Bacterial Agents/*pharmacology
MH  - Anti-Retroviral Agents/therapeutic use
MH  - Bacteria/classification/drug effects/isolation & purification
MH  - *Drug Resistance, Bacterial
MH  - Female
MH  - HIV Infections/drug therapy/epidemiology/*microbiology
MH  - Humans
MH  - Lung Diseases/drug therapy/epidemiology/*microbiology
MH  - Malawi/epidemiology
MH  - Male
MH  - Microbiota
MH  - Nasopharynx/microbiology
MH  - Prevalence
MH  - Risk Factors
MH  - Zimbabwe/epidemiology
PMC - PMC7908671
OTO - NOTNLM
OT  - Antibiotic resistance
OT  - Children
OT  - Chronic lung disease
OT  - HIV
OT  - Haemophilus influenzae
OT  - Moraxella catarrhalis
OT  - Staphylococcus aureus
OT  - Streptococcus pneumoniae
COIS- The authors declare that they have no competing interests.
EDAT- 2021/02/27 06:00
MHDA- 2021/03/20 06:00
PMCR- 2021/02/25
CRDT- 2021/02/26 05:37
PHST- 2020/11/29 00:00 [received]
PHST- 2021/02/12 00:00 [accepted]
PHST- 2021/02/26 05:37 [entrez]
PHST- 2021/02/27 06:00 [pubmed]
PHST- 2021/03/20 06:00 [medline]
PHST- 2021/02/25 00:00 [pmc-release]
AID - 10.1186/s12879-021-05904-3 [pii]
AID - 5904 [pii]
AID - 10.1186/s12879-021-05904-3 [doi]
PST - epublish
SO  - BMC Infect Dis. 2021 Feb 25;21(1):216. doi: 10.1186/s12879-021-05904-3.