ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2023
Risk Factors for Community Colonization With Extended-Spectrum Cephalosporin-Resistant Enterobacterales (ESCrE) in Botswana: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.
- Extended-spectrum β-lactamase production and antimicrobial resistance among Enterobacteriaceae causing clinical infections in Africa: a systematic review and meta-analysis (2012-2020).European journal of medical research · 2025Pooled it
- Factors influencing antibiotic-resistant bacteria colonization among community and hospitalized individuals in Chennai, India: an Antibiotic Resistance in Communities and Hospitals (ARCH) study.Antimicrobial resistance and infection control · 2026Article
- Spread of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) in the community living spaces of patients identified as ESBL-E carriers: impact of the housing density in an African context.Tropical medicine and health · 2026Article
- Risk Factors for Community Colonization With Extended-Spectrum Cephalosporin-Resistant Enterobacterales Among People Living With HIV in Botswana.Open forum infectious diseases · 2026Article
- Epidemiology of ESBL-Producing, Carbapenem-Resistant, and Carbapenemase-Producing Enterobacterales in Southern Africa.Antibiotics (Basel, Switzerland) · 2026Review
- Role of the gut microbiome in frequent gut colonization with extended-spectrum β lactamase-producing Enterobacterales among Peruvian children.Gut microbes · 2025Article
- Colonization with antibiotic resistant bacteria in communities and hospitals across six countries, including Bangladesh, Botswana, Chile, Guatemala, India, and Kenya.Scientific reports · 2025Article
- Risk factors associated with community colonization of extended-spectrum cephalosporin-resistant Enterobacterales from an antibiotic resistance in communities and hospitals (ARCH) study, Guatemala.Scientific reports · 2025Article
- Risk factors for household colonization by extended-spectrum cephalosporin-resistant enterobacterales (ESCrE) in Botswana.Antimicrobial resistance and infection control · 2025Article
- Admission screening for extended-spectrum cephalosporin-resistant and carbapenem-resistant Enterobacterales colonization at a referral hospital in Botswana: A one-year period-prevalence survey, 2022-2023.PLOS global public health · 2025Article
- Performance of CHROMagar ESBL media for the surveillance of extended-spectrum cephalosporin-resistantJournal of medical microbiology · 2023Article
- Using Colonization to Understand the Burden of Antimicrobial Resistance Across Low- and Middle-Income Countries.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- Antibiotic Resistance: A Global Problem and the Need to Do More.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
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Authors and funding
17 authors at 5 institutions in 3 countries.
Funding
Abstract
backgroundThe epidemiology of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) in low- and middle-income countries (LMICs) is poorly described. Identifying risk factors for ESCrE colonization is critical to inform antibiotic resistance reduction strategies because colonization is typically a precursor to infection.
methodsFrom 15 January 2020 to 4 September 2020, we surveyed a random sample of clinic patients at 6 sites in Botswana. We also invited each enrolled participant to refer up to 3 adults and children. All participants had rectal swabs collected that were inoculated onto chromogenic media followed by confirmatory testing. Data were collected on demographics, comorbidities, antibiotic use, healthcare exposures, travel, and farm and animal contact. Participants with ESCrE colonization (cases) were compared with noncolonized participants (controls) to identify risk factors for ESCrE colonization using bivariable, stratified, and multivariable analyses.
resultsA total of 2000 participants were enrolled. There were 959 (48.0%) clinic participants, 477 (23.9%) adult community participants, and 564 (28.2%) child community participants. The median (interquartile range) age was 30 (12-41) and 1463 (73%) were women. There were 555 cases and 1445 controls (ie, 27.8% of participants were ESCrE colonized). Independent risk factors (adjusted odds ratio [95% confidence interval]) for ESCrE included healthcare exposure (1.37 [1.08-1.73]), foreign travel [1.98 (1.04-3.77]), tending livestock (1.34 [1.03-1.73]), and presence of an ESCrE-colonized household member (1.57 [1.08-2.27]).
conclusionsOur results suggest healthcare exposure may be important in driving ESCrE. The strong links to livestock exposure and household member ESCrE colonization highlight the potential role of common exposure or household transmission. These findings are critical to inform strategies to curb further emergence of ESCrE in LMICs.
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