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Risk Factors for Community Colonization With Extended-Spectrum Cephalosporin-Resistant Enterobacterales Among People
Bogadi Loabile1,2,3, Ebbing Lautenbach1,2,4, Naledi Mannathoko5
1Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Open Forum Infectious Diseases
|February 6, 2026
Summary
Extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) colonization in people living with HIV (PLWH) was linked to recent hospitalization and household member colonization. Lower prevalence was observed post-COVID-19 lockdown, suggesting protective factors.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Public Health
Background:
- People living with HIV (PLWH) in sub-Saharan Africa face a research gap regarding extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE).
- Understanding ESCrE colonization burden and risk factors in non-hospitalized PLWH is crucial for targeted interventions.
Purpose of the Study:
- To identify risk factors associated with ESCrE colonization in non-hospitalized people living with HIV (PLWH).
Main Methods:
- Secondary data analysis of 546 non-hospitalized adult PLWH from a surveillance cohort in Botswana.
- Rectal swab sampling for ESCrE identification.
- Bivariate and multivariable analyses to determine risk factors for ESCrE colonization.
Main Results:
- 27.3% of participants screened positive for ESCrE rectal colonization.
- Independent risk factors for ESCrE colonization included recent hospitalization (aOR: 3.37), household member colonization (aOR: 1.74), and recruitment before COVID-19 lockdown (aOR: 2.01).
- Recent antibiotic use showed a non-significant elevated odds ratio for ESCrE colonization (aOR: 1.84).
Conclusions:
- Recent hospitalization and household ESCrE colonization are significant risk factors for ESCrE colonization in PLWH.
- A lower prevalence of ESCrE was observed following the COVID-19 lockdown, indicating potential protective factors.
- Further research is needed to understand the duration of these protective effects.
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