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However, the pathogenesis of CLD and its possible association with microbial determinants remain poorly understood. We investigated the prevalence, and antibiotic susceptibility of <jats:italic>Streptococcus pneumoniae<\/jats:italic> (SP), <jats:italic>Staphylococcus aureus<\/jats:italic> (SA), <jats:italic>Haemophilus influenzae<\/jats:italic> (HI), and <jats:italic>Moraxella catarrhalis<\/jats:italic> (MC) among CLWH (established on ART) who had CLD (CLD+), or not (CLD-) in Zimbabwe and Malawi.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Nasopharyngeal swabs (NP) and sputa were collected from CLD+ CLWH (defined as forced-expiratory volume per second\u00a0<jats:italic>z<\/jats:italic>-score\u2009&lt;\u2009\u2212\u20091 without reversibility post-bronchodilation with salbutamol), at enrolment as part of a randomised, placebo-controlled trial of azithromycin (BREATHE trial - <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02426112\">NCT02426112<\/jats:ext-link>), and from age- and sex-matched CLD- CLWH. Samples were cultured, and antibiotic susceptibility testing was conducted using disk diffusion. Risk factors for bacterial carriage were identified using questionnaires and analysed using multivariate logistic regression.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 410 participants (336 CLD+, 74 CLD-) were enrolled (median age, 15\u2009years [IQR\u2009=\u200913\u201318]). SP and MC carriage in NP were higher in CLD+ than in CLD- children: 46% (154\/336) vs. 26% (19\/74), <jats:italic>p<\/jats:italic>\u2009=\u20090.008; and 14% (49\/336) vs. 3% (2\/74), <jats:italic>p<\/jats:italic>\u2009=\u20090.012, respectively. SP isolates from the NP of CLD+ children were more likely to be non-susceptible to penicillin than those from CLD- children (36% [53\/144] vs 11% [2\/18], <jats:italic>p<\/jats:italic>\u2009=\u20090.036). Methicillin-resistant SA was uncommon [4% (7\/195)]. In multivariate analysis, key factors associated with NP bacterial carriage included having CLD (SP: adjusted odds ratio (aOR) 2 [95% CI 1.1\u20133.9]), younger age (SP: aOR 3.2 [1.8\u20135.8]), viral load suppression (SP: aOR 0.6 [0.4\u20131.0], SA: 0.5 [0.3\u20130.9]), stunting (SP: aOR 1.6 [1.1\u20132.6]) and male sex (SA: aOR 1.7 [1.0\u20132.9]). Sputum bacterial carriage was similar in both groups (50%) and was associated with Zimbabwean site (SP: aOR 3.1 [1.4\u20137.3], SA: 2.1 [1.1\u20134.2]), being on ART for a longer period (SP: aOR 0.3 [0.1\u20130.8]), and hot compared to rainy season (SP: aOR 2.3 [1.2\u20134.4]).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>CLD+ CLWH were more likely to be colonised by MC and SP, including penicillin-non-susceptible SP strains, than CLD- CLWH. The role of these bacteria in CLD pathogenesis, including the risk of acute exacerbations, should be further studied.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-021-05904-3","type":"journal-article","created":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T14:09:41Z","timestamp":1614262181000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Prevalence and antimicrobial resistance profiles of respiratory microbial flora in African children with HIV-associated chronic lung disease"],"prefix":"10.1186","volume":"21","author":[{"given":"Regina E.","family":"Abotsi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark P.","family":"Nicol","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace","family":"McHugh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Simms","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea M.","family":"Rehman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charmaine","family":"Barthus","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Slindile","family":"Mbhele","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brewster W.","family":"Moyo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucky G.","family":"Ngwira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hilda","family":"Mujuru","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beauty","family":"Makamure","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin","family":"Mayini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon \u00d8.","family":"Odland","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rashida A.","family":"Ferrand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix S.","family":"Dube","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,2,25]]},"reference":[{"key":"5904_CR1","unstructured":"HIV Statistics - Global and Regional Trends - UNICEF DATA. 2020.\u00a0https:\/\/data.unicef.org\/topic\/hivaids\/global-regional-trends\/. 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The University of Oxford waived approval. Additional ethical approval was received for this sub-study from the UCT HREC (HREC\/REF: 092\/2019). No additional data was collected other than that approved in the parent study. Written informed consent and assent were given by guardians and participants, respectively. Participants who were 18\u2009years old, and above at the time of enrolment consented independently. All data obtained and generated during the study were kept confidential. This research was conducted in accordance with the Declaration of Helsinki.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"216"}}