{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:50:16Z","timestamp":1792457416241,"version":"4.5.0"},"reference-count":36,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,3]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>Malnutrition is a leading risk factor for community-derived Enterobacterales bacteremia, which has a high rate of mortality in children in sub-Saharan Africa (SSA). International guidelines recommend the use of antibiotics, such as amoxicillin, for children with uncomplicated severe acute malnutrition (SAM), as well as parenteral broad-spectrum antibiotics, such as cephalosporins, for children with SAM who are admitted to the hospital. However, rising rates of infection with extended-spectrum cephalosporin-resistant Enterobacterales (ESCR-E) in SSA call this practice into question. To determine ESCR-E colonization rates, culture-based screening was performed on stool specimens collected from a cohort of children admitted to a hospital in Lilongwe, Malawi, for SAM. Of 188 individuals screened, 80.3% were positive for ESCR-E colonization, and 38.3% were colonized with multiple ESCR-E species. These findings reveal that high rates of ESCR-E colonization exist in some populations of malnourished children in SSA, and guideline-directed empiric antibiotic treatment may need to be reevaluated in this setting.<\/jats:p>","DOI":"10.4269\/ajtmh.25-0724","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T15:22:39Z","timestamp":1776352959000},"page":"1053-1057","source":"Crossref","is-referenced-by-count":1,"title":["Pervasive Intestinal Carriage with Multiple Species of Extended-Spectrum Cephalosporin-Resistant Enterobacterales in Children Admitted for Severe Acute Malnutrition at a Tertiary Hospital in Malawi"],"prefix":"10.4269","volume":"114","author":[{"given":"Thomas","family":"Holowka","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA;"},{"name":"Department of Medicine, Division of Infectious Diseases, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arrington","family":"Ashford","sequence":"additional","affiliation":[{"name":"North Carolina Agricultural and Technical State University, Greensboro, North Carolina, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trieu-Vi","family":"Khuu","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alisher","family":"Bimagambetov","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney N.","family":"Dial","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Kondwani","sequence":"additional","affiliation":[{"name":"Kamuzu Central Hospital, Lilongwe, Malawi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amazing-Grace","family":"Tepeka","sequence":"additional","affiliation":[{"name":"UNC Project-Malawi, Lilongwe, Malawi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Alby","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan J.","family":"Juliano","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA;"},{"name":"Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA;"},{"name":"Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony J.","family":"Garcia-Prats","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tisungane","family":"Mvalo","sequence":"additional","affiliation":[{"name":"UNC Project-Malawi, Lilongwe, Malawi;"},{"name":"Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan J.","family":"Vonasek","sequence":"additional","affiliation":[{"name":"UNC Project-Malawi, Lilongwe, Malawi;"},{"name":"Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily J.","family":"Ciccone","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA;"},{"name":"Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luther A.","family":"Bartelt","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA;"},{"name":"Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA;"},{"name":"Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"issue":"2","key":"b1","series-title":"Lancet Glob Health","first-page":"e201","article-title":"The burden of bacterial antimicrobial resistance in the WHO African region in 2019: A cross-country systematic analysis","volume":"12","year":"2024"},{"issue":"1","key":"b2","series-title":"N Engl J Med","first-page":"39","article-title":"Bacteremia among children admitted to a rural hospital in Kenya","volume":"352","author":"Berkley","year":"2005"},{"issue":"2","key":"b3","series-title":"JAC Antimicrob Resist","first-page":"dlad051","article-title":"Impact of childhood malnutrition and intestinal microbiota on MDR infections","volume":"5","author":"Holowka","year":"2023"},{"key":"b4","article-title":"WHO Guideline on the Prevention and Management of Wasting and Nutritional Oedema (Acute Malnutrition) in Infants and Children under 5 Years.","year":"2023"},{"key":"b5","series-title":"Paediatr Int Child Health","first-page":"S1","article-title":"Severe acute malnutrition and infection","volume":"34","author":"Jones","year":"2014"},{"key":"b6","series-title":"EClinicalMedicine","first-page":"102512","article-title":"Antimicrobial resistance in Enterobacterales infections among children in sub-Saharan Africa: A systematic review and meta-analysis","volume":"70","author":"Kowalski","year":"2024"},{"issue":"1","key":"b7","series-title":"J Pediatric Infect Dis Soc","first-page":"piae120","article-title":"Infections and antibiotic resistance in Malawian children under five-years old hospitalized with severe acute malnutrition","volume":"14","author":"Vonasek","year":"2025"},{"issue":"12","key":"b8","series-title":"Clin Infect Dis","first-page":"2053","article-title":"Increased relative abundance of Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae within the gut microbiota is associated with risk of bloodstream infection in long-term acute care hospital patients","volume":"68","author":"Shimasaki","year":"2019"},{"key":"b9","series-title":"Performance Standards for Antimicrobial Susceptibility Testing, 35th ed","year":"2025"},{"key":"b10","article-title":"African Union AMR Landmark Report: Voicing African Priorities on the Active Pandemic.","year":"2024"},{"key":"b11","series-title":"EClinicalMedicine","first-page":"102508","article-title":"Carriage of third-generation cephalosporin-resistant and carbapenem-resistant Enterobacterales among children in sub-Saharan Africa: A systematic review and meta-analysis","volume":"70","author":"Ruef","year":"2024"},{"issue":"4","key":"b12","series-title":"mSphere","first-page":"e00428-20","article-title":"Horizontal plasmid transfer among Klebsiella pneumoniae isolates is the key factor for dissemination of extended-spectrum beta-lactamases among children in Tanzania","volume":"5","author":"Pedersen","year":"2020"},{"key":"b13","article-title":"Protein malnutrition facilitates intestinal colonization with highly resistant Klebsiella pneumoniae","author":"Holowka","year":"2025"},{"issue":"12","key":"b14","series-title":"Nat Microbiol","first-page":"2164","article-title":"Escherichia coli limits Salmonella Typhimurium infections after diet shifts and fat-mediated microbiota perturbation in mice","volume":"4","author":"Wotzka","year":"2019"},{"issue":"1","key":"b15","series-title":"Clin Infect Dis","first-page":"1","article-title":"Risk factors, temporal dependence, and seasonality of human extended-spectrum beta-lactamases-producing Escherichia coli and Klebsiella pneumoniae colonization in Malawi: A longitudinal model-based approach","volume":"77","author":"Sammarro","year":"2023"},{"issue":"3","key":"b16","series-title":"J Antimicrob Chemother","first-page":"709","article-title":"Increased risk of acquisition and transmission of 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