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

J Med Microbiol. 2017 May;66(5):609-615. doi: 10.1099/jmm.0.000474. Epub 2017 May 18.

Abstract

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.

MeSH terms

  • Adolescent
  • Ambulatory Care
  • Anti-Bacterial Agents
  • Antiretroviral Therapy, Highly Active
  • CD4 Lymphocyte Count
  • Carrier State / epidemiology*
  • Carrier State / microbiology
  • Child
  • Ciprofloxacin / pharmacology
  • Enterobacteriaceae / drug effects
  • Enterobacteriaceae / enzymology*
  • Enterobacteriaceae / genetics
  • Enterobacteriaceae / isolation & purification*
  • Enterobacteriaceae Infections / complications*
  • Enterobacteriaceae Infections / epidemiology*
  • Enterobacteriaceae Infections / microbiology
  • Feces / microbiology
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology
  • HIV Infections / virology
  • Humans
  • Male
  • Microbial Sensitivity Tests
  • Prevalence
  • Zimbabwe / epidemiology
  • beta-Lactamases / biosynthesis*
  • beta-Lactamases / genetics

Substances

  • Anti-Bacterial Agents
  • Ciprofloxacin
  • beta-Lactamases