{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T04:41:13Z","timestamp":1773204073489,"version":"3.50.1"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["U3HCK000015-01-00"],"award-info":[{"award-number":["U3HCK000015-01-00"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>\n                    Extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) are significant contributors to infection-related mortality in low- and middle-income countries. Colonization with ESCrE and\/or CRE can precede infection and serve as a reservoir for transmission within healthcare facilities and the community.We conducted a 12-month period-prevalence study, screening patients for ESCrE and CRE upon admission to a referral tertiary hospital Emergency Department in Botswana. Rectal swabs were collected within 24 hours of hospital arrival. Colonization was identified using selective culture media and confirmed using automated susceptibility testing. Associations between ESCrE\/CRE colonization, and clinical and demographic variables were analysed using univariate and multivariable logistic regression. Among 802 patients, 24.1% (n\u2009=\u2009193) were colonized with ESCrE, and 1.5% (n\u2009=\u200912) with CRE. ESCrE colonization was associated with recent hospitalization (within the last six months) (aOR 1.76, 95% CI 1.11-2.79), borehole water use (aOR 3.95, 95% CI 1.12-13.87), indwelling medical devices (aOR 2.19, 95% CI 1.08-4.48), and age\u2009&lt;\u20091 year (aOR 2.09, 95% CI 1.32-3.30). CRE colonization was associated with antiretroviral drug use (cOR 6.60, 95% CI 1.72-25.36). Infants (&lt;1 year) had over three times the odds of ESCr\/CR-\n                    <jats:italic>\n                      <jats:italic>Klebsiella<\/jats:italic>\n                    <\/jats:italic>\n                    spp\n                    <jats:italic>.<\/jats:italic>\n                    colonization compared to adults (cOR 3.60, 95% CI 1.82-7.13). Infant age, recent healthcare exposure, indwelling medical devices, and borehole water use were key risk factors for ESCrE colonization, highlighting the need for targeted infection prevention strategies in Botswana. The identified potential association between CRE colonization and antiretroviral drug use warrants further investigation to elucidate any possible links and drivers between HIV care and antimicrobial resistance.\n                  <\/jats:p>","DOI":"10.1371\/journal.pgph.0005018","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T17:23:42Z","timestamp":1761672222000},"page":"e0005018","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["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\u20132023"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3505-7326","authenticated-orcid":true,"given":"Tshiamo","family":"Zankere","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kwana","family":"Lechiile","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kitso","family":"Mokgwathi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nametso","family":"Tlhako","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Banno","family":"Moorad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tlhalefo D.","family":"Ntereke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresia","family":"Gatonye","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ebbing","family":"Lautenbach","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6717-8856","authenticated-orcid":true,"given":"Melissa","family":"Richard-Greenblatt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret","family":"Mokomane","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mosepele","family":"Mosepele","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corrado","family":"Cancedda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David M.","family":"Goldfarb","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4682-8087","authenticated-orcid":true,"given":"Ashley","family":"Styczynski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7236-8969","authenticated-orcid":true,"given":"Gemma","family":"Parra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel M.","family":"Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9429-2838","authenticated-orcid":true,"given":"Naledi","family":"Mannathoko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5258-7654","authenticated-orcid":true,"given":"Jonathan","family":"Strysko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,10,28]]},"reference":[{"issue":"10325","key":"pgph.0005018.ref001","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","volume":"399","author":"Antimicrobial Resistance Collaborators","year":"2022","journal-title":"Lancet"},{"key":"pgph.0005018.ref002","article-title":"Neonatal sepsis and antimicrobial resistance in Africa","author":"PY Iroh Tam","year":"2023","journal-title":"Lancet Child Adolesc Health"},{"issue":"6","key":"pgph.0005018.ref003","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1038\/s41564-022-01124-w","article-title":"A bottom-up view of antimicrobial resistance transmission in developing countries","volume":"7","author":"OO Ikhimiukor","year":"2022","journal-title":"Nat Microbiol"},{"key":"pgph.0005018.ref004","doi-asserted-by":"crossref","first-page":"127249","DOI":"10.1016\/j.micres.2022.127249","article-title":"Global spread of carbapenem-resistant Enterobacteriaceae: epidemiological features, resistance mechanisms, detection and therapy","volume":"266","author":"J Ma","year":"2023","journal-title":"Microbiol Res"},{"key":"pgph.0005018.ref005","unstructured":"World Health Organization. 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Vital statistics report. 2020."},{"issue":"7","key":"pgph.0005018.ref030","doi-asserted-by":"crossref","first-page":"3997","DOI":"10.1128\/AAC.02558-14","article-title":"Pediatric infection and intestinal carriage due to extended-spectrum-cephalosporin-resistant Enterobacteriaceae","volume":"58","author":"DM Zerr","year":"2014","journal-title":"Antimicrob Agents Chemother"},{"issue":"9","key":"pgph.0005018.ref031","article-title":"Deciphering the gastrointestinal carriage of Klebsiella pneumoniae","volume":"92","author":"AS Bray","year":"2024","journal-title":"Infect Immun"},{"key":"pgph.0005018.ref032","doi-asserted-by":"crossref","DOI":"10.1093\/cid\/ciad223","article-title":"Risk factors for colonization with multidrug-resistant bacteria in urban and rural communities in Kenya: an antimicrobial resistance in communities and hospitals (ARCH) study","volume":"77","author":"MA Caudell","year":"2023","journal-title":"Clin Infect 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