Carriage of extended-spectrum beta-lactamase-producing enterobacteriaceae in HIV-infected children in Zimbabwe

S. M.S. Wilmore*, K. Kranzer, A. Williams, B. Makamure, A. F. Nhidza, J. Mayini, T. Bandason, J. Metcalfe, M. P. Nicol, I. Balakrishnan, M. J. Ellington, N. Woodford, S. Hopkins, T. D. McHugh, R. A. Ferrand

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)


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.

Original languageEnglish
Article number000474
Pages (from-to)609-615
Number of pages7
JournalJournal of Medical Microbiology
Issue number5
Publication statusPublished - May 2017

Bibliographical note

Publisher Copyright:
© 2017 The Authors.


  • Africa
  • Antimicrobial resistance
  • Beta-lactamase Enterobacteriaceae
  • ESBL
  • Extended-spectrum
  • HIV


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