2022
DOI: 10.1038/s41564-022-01216-7
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Colonization dynamics of extended-spectrum beta-lactamase-producing Enterobacterales in the gut of Malawian adults

Abstract: Drug-resistant bacteria of the order Enterobacterales which produce extended-spectrum beta-lactamase enzymes (ESBL-Enterobacterales, ESBL-E) are global priority pathogens. Antimicrobial stewardship interventions proposed to curb their spread include shorter courses of antimicrobials to reduce selection pressure but individual-level acquisition and selection dynamics are poorly understood. We sampled stool of 425 adults (aged 16–76 years) in Blantyre, Malawi, over 6 months and used multistate modelling and whol… Show more

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Cited by 19 publications
(17 citation statements)
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“…This represents 64 % (473/641) of all E. coli identified by culture in the parent study; a full description of study participants and temporal trends has previously been made [16]; ESBL E. coli carriage prevalence was more common in hospitalised participants, which explains the preponderance of genomes from this cohort in this analysis.…”
Section: Resultsmentioning
confidence: 92%
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“…This represents 64 % (473/641) of all E. coli identified by culture in the parent study; a full description of study participants and temporal trends has previously been made [16]; ESBL E. coli carriage prevalence was more common in hospitalised participants, which explains the preponderance of genomes from this cohort in this analysis.…”
Section: Resultsmentioning
confidence: 92%
“…The clinical study which provided the isolates for this analysis was approved by the Liverpool School of Tropical Medicine Research Ethics Committee (16-062) and University of Malawi College of Medicine Research Ethics Committee (COMREC P.11/16/2063). The isolates analysed in this study were selectively cultured from stool and rectal swabs collected from adults in Blantyre, Malawi, as part of a study of longitudinal carriage of ESBL-producing Enterobacterales, as previously described [16]. Briefly, three groups of adults (≥ 16 years) were recruited following informed consent to participate in the study: i) 225 adults with sepsis, empirically treated with antibiotics in the emergency department of Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi; ii) 100 antimicrobial-unexposed adult inpatients at QECH; and iii) 100 antimicrobial-unexposed adults recruited from the community.…”
Section: Methodsmentioning
confidence: 99%
“…Following quality control, 473 E. coli genomes sequenced for this study were included in the analysis, 440 from participants enrolled in hospital, and 33 from community members, with a median 2 (IQR 1-5) samples per participant. A full description of study participants and temporal trends has previously been made 15 . The most common phylogroup was A (43%), followed by phylogroup B2 (20%), B1 (9%), C (9%), F (8%) and D (5%), with nine samples untyped by the Clermont scheme (Figure 1A).…”
Section: Resultsmentioning
confidence: 99%
“…The clinical study which provided the isolates for this analysis was approved by the Liverpool School of Tropical Medicine Research Ethics Committee (16-062) and University of Malawi College of Medicine Research Ethics Committee (COMREC P.11/16/2063). The isolates analysed in this study were selectively cultured from stool and rectal swabs collected from adults in Blantyre, Malawi, as part of a study of longitudinal carriage of ESBL-producing Enterobacterales, as previously described 15 .…”
Section: Methodsmentioning
confidence: 99%
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