title: Carriage of antibiotic-resistantEnterobacteriaceaein hospitalised children in tertiary hospitals in Harare, Zimbabwe.
abstract: BACKGROUND
  Extended-spectrum β-lactamase-producing and gentamicin resistantEnterobacteriaceaeare increasingly recognised as a major cause of infection in low-income countries. We assessed the prevalence of gastrointestinal carriage of these bacteria in hospitalised children in Harare, Zimbabwe.
  
  
  METHODS
  We conducted a cohort study in paediatric inpatients at two tertiary-referral hospitals between May and July 2015. Rectal swabs and faecal samples were collected within 24 h of admission and further follow-up samples were collected on alternate days during hospitalization. Disc-based, selective and enrichment methods were used to detect carriage of these two forms of resistance. Standard methods were used to confirm resistance status and determine the susceptibility of resistant isolates to other commonly-used antibiotics.
  
  
  RESULTS
  One hundred and sixty four paediatric inpatient admissions (median age = 1.0 year, IQR = 0.2-2.2years) were enrolled, and an average of 1.9 faecal samples per patient were collected. On admission, 68/164 (41%) patients had both ESBL and gentamicin-resistantEnterobacteriaceaedetected, 18 (11%) had ESBL only, 17 (10%) had gentamicin resistance only and 61 (37%) had negative screening for both forms of resistance. During hospitalisation, 32/164 (20%) patients were found to have a type of resistant organism which was not present in their admission sample. We found that faecal samples and use of a selective enrichment broth enhanced the detection of resistant organisms. Amongst resistant bacteria isolated, there were high levels of resistance to ciprofloxacin and chloramphenicol, but not ertapenem.
  
  
  CONCLUSIONS
  More than half of children had enteric carriage of a clinically-relevant form of antibiotic resistance on admission to public-sector hospitals in urban Zimbabwe. Additionally, a fifth of children acquired a further form of resistance during hospitalisation. Urgent action is needed to tackle the spread of antibiotic resistant enteric bacteria in African hospitals.
authors.affiliation: College of Health Sciences, Department of Medical Microbiology, University of Zimbabwe, PO Box A178, Harare, Zimbabwe.
authors.forename: Marcelyn T
authors.identifier: 0000-0002-1371-8615
authors.initials: MT
authors.lastname: Magwenzi
authors.affiliation: National Microbiology Reference Laboratory, Harare Central Hospital, Harare, Zimbabwe.
authors.forename: Muchaneta
authors.initials: M
authors.lastname: Gudza-Mugabe
authors.affiliation: College of Health Sciences, Department of Paediatrics and Child Health, University of Zimbabwe, Harare, Zimbabwe ; Harare Central Hospital, Harare, Zimbabwe.
authors.forename: Hilda A
authors.initials: HA
authors.lastname: Mujuru
authors.affiliation: College of Health Sciences, Department of Paediatrics and Child Health, University of Zimbabwe, Harare, Zimbabwe ; Parirenyatwa Group of Hospitals, Harare, Zimbabwe.
authors.forename: Mutsa
authors.initials: M
authors.lastname: Dangarembizi-Bwakura
authors.affiliation: College of Health Sciences, Department of Medical Microbiology, University of Zimbabwe, PO Box A178, Harare, Zimbabwe ; Biomedical Research and Training Institute, Harare, Zimbabwe.
authors.forename: Valerie
authors.initials: V
authors.lastname: Robertson
authors.affiliation: Biomedical Research and Training Institute, Harare, Zimbabwe ; London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Aiken
keywords: Antibiotic resistance; Children; Colonization; ESBL; Enterobacteriaceae