{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T09:40:59Z","timestamp":1790415659917,"version":"4.1.0"},"reference-count":47,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,9,29]],"date-time":"2021-09-29T00:00:00Z","timestamp":1632873600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"African Centre of Excellence in Public Health and Herbal Medicine (ACEPHEM)","award":["P151847"],"award-info":[{"award-number":["P151847"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Antimicrobial resistance due to extended-spectrum \u03b2-lactamase (ESBL) production by Enterobacterales is a global health problem contributing to increased morbidity and mortality, particularly in resource-constrained countries. We aimed to determine the prevalence of extended-spectrum \u03b2-lactamase-producing Enterobacterales (ESBL-E) in community patients in Blantyre, Malawi. Clinical samples were collected from 300 patients and screened for ESBL-E using a CHROMagarTM ESBL medium. Confirmation of ESBL production was done by a combination disk test (CDT). The prevalence of community-acquired ESBL-E was 16.67% (50\/300, 95% CI = 12.43\u201320.91%). The most common ESBL-E species isolated was Escherichia coli (66%). All ESBL-E isolates were resistant to Trimethoprim-Sulfamethoxazole except for 2% of E. coli. Besides this, all ESBL-E were susceptible to Imipenem and only 4% were resistant to Meropenem. No patients with a positive ESBL-E phenotype had a history of hospital admission in the last three months, and the carriage of ESBL-E was neither associated with the demographic nor the clinical characteristics of participants. Our findings reveal a low presence of ESBL-E phenotypes in community patients. The low prevalence of ESBL-E in the community settings of Blantyre can be maintained if strong infection and antimicrobial use-control strategies are implemented.<\/jats:p>","DOI":"10.3390\/tropicalmed6040179","type":"journal-article","created":{"date-parts":[[2021,10,11]],"date-time":"2021-10-11T01:59:47Z","timestamp":1633917587000},"page":"179","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Carriage Prevalence of Extended-Spectrum \u03b2-Lactamase Producing Enterobacterales in Outpatients Attending Community Health Centers in Blantyre, Malawi"],"prefix":"10.3390","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8954-2794","authenticated-orcid":false,"given":"Onduru Gervas","family":"Onduru","sequence":"first","affiliation":[{"name":"The Africa Center of Excellence in Public Health and Herbal Medicine (ACEPHEM), Kamuzu University of Health Sciences, Blantyre Private Bag 360, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajhab Sawasawa","family":"Mkakosya","sequence":"additional","affiliation":[{"name":"Department of Pathology, Kamuzu University of Health Sciences, Blantyre Private Bag 360, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan Fred","family":"Rumisha","sequence":"additional","affiliation":[{"name":"Directorate of Information Technology and Communication, National Institute for Medical Research, P.O. Box 9653 Dar es Salaam, Tanzania"},{"name":"Malaria Atlas Project, Geospatial Health and Development, Telethon Kids Institute, Perth, WA 6009, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Said","family":"Aboud","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001 Dar es Salaam, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1697","DOI":"10.1128\/AAC.35.9.1697","article-title":"More extended-spectrum \u03b2-lactamases","volume":"35","author":"Jacoby","year":"1991","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1007\/BF01641355","article-title":"Transferable resistance to cefotaxime, cefoxitin, cefamandole and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens","volume":"11","author":"Knothe","year":"1983","journal-title":"Infection"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/S1473-3099(17)30753-3","article-title":"Discovery, research, and development of new antibiotics: The WHO priority list of antibiotic-resistant bacteria and tuberculosis","volume":"18","author":"Tacconelli","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_4","unstructured":"Rossolini, G.M., and Mantengoli, E. Antimicrobial resistance in Europe and its potential impact on empirical therapy. Clinical Microbiology and Infection, Blackwell Publishing Ltd."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1128\/CMR.00023-13","article-title":"Trends in human fecal carriage of extended-spectrum \u03b2-lactamases in the community: Toward the globalization of CTX-M","volume":"26","author":"Woerther","year":"2013","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1093\/jac\/dkq008","article-title":"High prevalence of CTX-M b-lactamase-producing Enterobacteriaceae in stool specimens obtained from healthy individuals in Thailand","volume":"65","author":"Sasaki","year":"2010","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s13756-017-0208-x","article-title":"The threat of antimicrobial resistance in developing countries: Causes and control strategies","volume":"6","author":"Ayukekbong","year":"2017","journal-title":"Antimicrob. Resist. Infect. Control."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/j.cmi.2015.12.002","article-title":"The negative impact of antibiotic resistance","volume":"22","author":"Friedman","year":"2016","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1179\/2047773215Y.0000000030","article-title":"Antimicrobial resistance: A global multifaceted phenomenon","volume":"109","author":"Prestinaci","year":"2015","journal-title":"Pathog. Glob. Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1093\/jac\/dkz032","article-title":"Genomic analysis of Klebsiella pneumoniae isolates from Malawi reveals acquisition of multiple ESBL determinants across diverse lineages","volume":"74","author":"Musicha","year":"2019","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1093\/jac\/dkl037","article-title":"Identification and characterization of ceftriaxone resistance and extended-spectrum \u03b2-lactamases in Malawian bacteraemic Enterobacteriaceae","volume":"57","author":"Gray","year":"2006","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1016\/S1473-3099(17)30394-8","article-title":"Trends in antimicrobial resistance in bloodstream infection isolates at a large urban hospital in Malawi (1998\u20132016): A surveillance study","volume":"17","author":"Musicha","year":"2017","journal-title":"Lancet Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.jgar.2019.12.017","article-title":"Emergence of carbapenemase-producing Enterobacteriaceae in Malawi","volume":"20","author":"Lewis","year":"2020","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_14","first-page":"1","article-title":"Sample size determination in health studies: A practical manual","volume":"88","author":"Lwanga","year":"1991","journal-title":"World Health Organ. Geneva"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1136\/jcp.46.10.975-a","article-title":"Cowan and Steel\u2019s manual for the identification of medical bacteria","volume":"46","author":"Phillips","year":"1993","journal-title":"J. Clin. Pathol."},{"key":"ref_16","unstructured":"Wayne, P. (2020). M100 Performance Standards for Antimicrobial Susceptibility Testing A CLSI Supplement for Global Application, Clinical and Laboratory Standards Institute. [30th ed.]. Available online: www.clsi.org."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1093\/jac\/45.6.881","article-title":"Detection of extended-spectrum \u03b2-lactamases in members of the family Enterobacteriaceae: Comparison of the MAST DD test, the double disc and the Etest ESBL","volume":"45","author":"Chanawong","year":"2000","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/j.ijmm.2017.07.006","article-title":"Molecular epidemiology of Klebsiella pneumoniae invasive infections over a decade at Kilifi County Hospital in Kenya","volume":"307","author":"Henson","year":"2017","journal-title":"Int. J. Med. Microbiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.9734\/BMRJ\/2014\/9792","article-title":"Prevalence and genotypic characterization of extended-spectrum beta-lactamases produced by gram negative bacilli at a Tertiary Care Hospital in Rural South Western Uganda","volume":"4","author":"Moses","year":"2014","journal-title":"Br. Microbiol. Res. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1756-0500-7-374","article-title":"Antimicrobial resistance in urinary isolates from inpatients and outpatients at a tertiary care hospital in South-Kivu Province (Democratic Republic of Congo)","volume":"7","author":"Irenge","year":"2014","journal-title":"BMC Res. Notes"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/j.vetmic.2014.02.014","article-title":"Antimicrobial-resistant enterobacteriaceae from humans and wildlife in Dzanga-Sangha Protected Area, Central African Republic","volume":"171","author":"Janatova","year":"2014","journal-title":"Vet. Microbiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1186\/1471-2180-12-155","article-title":"Analysis of -lactamase phenotypes and carriage of selected -lactamase genes among Escherichia coli strains obtained from Kenyan patients during an 18-year period","volume":"12","author":"Kiiru","year":"2012","journal-title":"BMC Microbiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"470","DOI":"10.3855\/jidc.1456","article-title":"Genotypes and cephalosporin susceptibility in extended-spectrum beta-lactamase producing enterobacteriaceae in the community","volume":"6","author":"Maina","year":"2011","journal-title":"J. Infect. Dev. Ctries"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Almagor, J., Temkin, E., Benenson, I., Fallach, N., and Carmeli, Y. (2018). DRIVE-AB consortium. The impact of antibiotic use on transmission of resistant bacteria in hospitals: Insights from an agent-based model. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0197111"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.2147\/IDR.S173867","article-title":"Antibiotic resistance: A rundown of a global crisis","volume":"11","author":"Aslam","year":"2018","journal-title":"Infect. Drug Resist."},{"key":"ref_26","first-page":"363","article-title":"Extended-spectrum \u03b2-lactamases in enterobacteriaceae: Related to age and gender","volume":"25","author":"Shah","year":"2002","journal-title":"New Microbiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"30","DOI":"10.4103\/0976-9668.127280","article-title":"Study of extended spectrum \u03b2-lactamase producing enterobacteriaceae and antibiotic coresistance in a tertiary care teaching hospital","volume":"5","author":"Shashwati","year":"2014","journal-title":"J. Nat. Sci. Biol. Med."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Tellevik, M.G., Blomberg, B., Kommedal, \u00d8., Maselle, S.Y., Langeland, N., and Moyo, S.J. (2016). High prevalence of faecal carriage of ESBL-producing enterobacteriaceae among children in Dar es Salaam, Tanzania. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0168024"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Moyo, S.J., Aboud, S., Kasubi, M., Lyamuya, E.F., and Maselle, S.Y. (2010). Antimicrobial resistance among producers and non-producers of extended spectrum beta-lactamases in urinary isolates at a tertiary Hospital in Tanzania. BMC Res. Notes, 3.","DOI":"10.1186\/1756-0500-3-348"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40360-015-0013-1","article-title":"Phenotypic expression and prevalence of ESBL-producing Enterobacteriaceae in samples collected from patients in various wards of Mulago Hospital, Uganda","volume":"16","author":"Kateregga","year":"2015","journal-title":"BMC Pharmacol. Toxicol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e33","DOI":"10.1016\/S1473-3099(17)30467-X","article-title":"Antimicrobial resistance among children in sub-Saharan Africa","volume":"18","author":"Williams","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s13756-019-0488-4","article-title":"Extended-spectrum beta-lactamase production and multi-drug resistance among enterobacteriaceae isolated in Addis Ababa, Ethiopia","volume":"8","author":"Teklu","year":"2019","journal-title":"Antimicrob. Resist. Infect. Control."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Ouedraogo, A.S., Sanou, M., Kissou, A., Sanou, S., Solar\u00e9, H., Kabor\u00e9, F., Poda, A., Aberkane, S., Bouzinbi, N., and Sano, I. (2016). High prevalence of extended-spectrum \u03b2-lactamase producing enterobacteriaceae among clinical isolates in Burkina Faso. BMC Infect. Dis., 11.","DOI":"10.1186\/s12879-016-1655-3"},{"key":"ref_34","first-page":"1","article-title":"Prevalence, risk factors and genetic characterisation of extended-spectrum beta-lactamase and carbapenemase-producing Enterobacteriaceae (ESBL-E and CPE): A community-based cross-sectional study, the Netherlands, 2014 to 2016","volume":"24","author":"Hidalgo","year":"2019","journal-title":"Eurosurveillance"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Najjuka, C.F., Kateete, D.P., Kajumbula, H.M., Joloba, M.L., and Essack, S.Y. (2016). Antimicrobial susceptibility profiles of Escherichia coli and Klebsiella pneumoniae isolated from outpatients in urban and rural districts of Uganda. BMC Res. Notes, 9.","DOI":"10.1186\/s13104-016-2049-8"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"007","DOI":"10.4103\/0974-2727.129083","article-title":"Extended-spectrum beta-lactamases producing Escherichia coli and Klebsiella pneumoniaei: A multi-centric study across Karnataka","volume":"6","author":"Rao","year":"2014","journal-title":"J. Lab. Physicians"},{"key":"ref_37","first-page":"1","article-title":"High prevalence and characterization of extended-spectrum \u03b2-lactamase producing Enterobacteriaceae in Chadian hospitals","volume":"19","author":"Mahamat","year":"2019","journal-title":"BMC Infect. Dis."},{"key":"ref_38","first-page":"273","article-title":"National Antibiotic Surveillance Forum. Antimicrobial susceptibility profile of selected bacteraemic pathogens from private institutions in South Africa","volume":"97","author":"Brink","year":"2007","journal-title":"S. Afr. Med. J."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Sanneh, B., Kebbeh, A., Jallow, H.S., Camara, Y., Mwamakamba, L.W., Ceesay, I.F., Barrow, E., Sowe, F.O., Sambou, S.M., and Baldeh, I. (2018). Prevalence and risk factors for faecal carriage of extended spectrum \u03b2-lactamase producing enterobacteriaceae among food handlers in lower basic schools in West Coast Region of The Gambia. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0200894"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"13362","DOI":"10.1038\/s41598-021-92819-3","article-title":"Prevalence and risk factors for faecal carriage of multidrug resistant Escherichia coli among slaughterhouse workers","volume":"11","author":"Aworh","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Lonchel, C.M., Meex, C., Gangou\u00e9-Pi\u00e9boji, J., Boreux, R., Assoumou, M.C., Melin, P., and De Mol, P. (2012). Proportion of extended-spectrum \u00df-lactamase-producing Enterobacteriaceae in community setting in Ngaoundere, Cameroon. BMC Infect. Dis., 12.","DOI":"10.1186\/1471-2334-12-53"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.3201\/eid1908.130257","article-title":"Extended-spectrum \u03b2-lactamase-producing enterobacteriaceae among travelers from the Netherlands","volume":"19","author":"Paltansing","year":"2013","journal-title":"Emerg. Infect. Dis."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1093\/cid\/ciu957","article-title":"Antimicrobials increase travelers\u2019 risk of colonization by extended-spectrum betalactamase-producing enterobacteriaceae","volume":"60","author":"Kantele","year":"2015","journal-title":"Clin. Infect. Dis."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1111\/j.1708-8305.2011.00548.x","article-title":"Colonization of returning travelers with CTX-M-producing Escherichia coli","volume":"18","author":"Peirano","year":"2011","journal-title":"J. Travel Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2021\/5153237","article-title":"Genetic determinants of resistance among ESBL-producing enterobacteriaceae in community and hospital settings in east, central, and Southern Africa: A systematic review and meta-analysis of prevalence","volume":"2021","author":"Onduru","year":"2021","journal-title":"Can. J. Infect. Dis. Med. Microbiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.jhin.2018.05.017","article-title":"High carriage rate of extended-spectrum beta-lactamase-producing Enterobacteriaceae among patients admitted for surgery in Tanzanian hospitals with a low rate of endogenous surgical site infections","volume":"100","author":"Moremi","year":"2018","journal-title":"J. Hosp. Infect."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2140","DOI":"10.1093\/jac\/dkt164","article-title":"High burden of extended-spectrum \u03b2-lactamase-producing enterobacteriaceae in Gabon","volume":"68","author":"Schaumburg","year":"2013","journal-title":"J. Antimicrob. Chemother."}],"container-title":["Tropical Medicine and Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2414-6366\/6\/4\/179\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:07:05Z","timestamp":1760166425000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2414-6366\/6\/4\/179"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,29]]},"references-count":47,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["tropicalmed6040179"],"URL":"https:\/\/doi.org\/10.3390\/tropicalmed6040179","relation":{},"ISSN":["2414-6366"],"issn-type":[{"value":"2414-6366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,29]]}}}