{ "abstract": "Introduction: Over 300,000 babies are born annually with sickle cell anemia (SCA) in sub-Saharan Africa. Despite malaria chemoprevention and early penicillin prophylaxis, these children develop febrile illnesses. The effect of malaria chemoprevention regimens on the incidence of bacterial infections and antimicrobial resistance is unclear. We assessed incidence of bacterial infections and resistance patterns in children with SCA receiving weekly DP or monthly SP. Methods: This study was nested in a randomized, double-blind clinical trial comparing weekly DP with monthly SP. Participants were children aged 6 months to 15 years with SCA, followed every two months for a median of 14.7 months (IQR 11.2–18.2) and evaluated at all sick visits. Blood cultures were obtained for episodes of fever (axillary temperature >38℃) and processed using the BD BACTEC automated system. Bacterial identification was by phenotypic and genotypic methods. Whole-genome sequencing was performed using Illumina DNA Prep Kit, and antimicrobial resistance genes were characterized using AMRFinderPlus. Analyses were conducted in STATA 18.0 and limited to Ugandan participants. Results: Of 725 enrolled participants, 437 were from Uganda (221 DP; 216 SP). The mean (SD) age was 7.3 (3.8) years, and 52.4% were male. Pathogenic bacteria were rarely isolated, including Escherichia coli (3), Klebsiella pneumoniae (2), Staphylococcus aureus (2), Streptococcus agalactiae. (1), and Enterococcus faecalis (1). The cumulative incidence of bacterial growth over 22 months of follow-up was 2.3% (95% CI: 1.12–4.73). Children with positive cultures tended to have higher fevers and more hospitalizations. All isolates were multidrug-resistant. Multiple resistance genes were identified, including plasmid-mediated sulfonamide resistance via sul2 in both Klebsiella pneumoniae and Escherichia coli. Conclusion: Pathogenic bacteria were infrequently isolated from Ugandan children with SCA receiving malaria chemoprevention. The presence of sul2 indicates the possibility of plasmid-mediated sulfonamide resistance.", "abstract_shown": true, "affiliations": [ "Department of Pharmacy, College of Health Sciences, Makerere University, Kampala, Uganda", "Department of Pharmacology and Therapeutics, College of Health Sciences, Makerere University, Kampala, Uganda", "Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda", "Global Health Uganda, Kampala, Uganda", "National Microbiology Reference Laboratory, National Health Laboratory and Diagnostic Services, Ministry of Health, Kampala, Uganda", "Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda", "Training and Research Unit of Excellence, Blantyre, Malawi", "Department of Epidemiology and Biostatistics, Makerere University, College of Health Sciences, Kampala, Uganda", "Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom", "School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi", "Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway" ], "article_type": "Research Article", "arxiv": null, "author_total": 16, "authors": [ { "affs": [ 0 ], "name": "Winnie Nambatya" }, { "affs": [ 1 ], "name": "Moses Ocan" }, { "affs": [ 2 ], "name": "Grace Ndeezi" }, { "affs": [ 3 ], "name": "Dennis Kalibbala" }, { "affs": [ 4 ], "name": "Ritah Namusoosa" }, { "affs": [ 5 ], "name": "Freddie Bwanga" }, { "affs": [ 6 ], "name": "Thandile Nkosi-Gondwe" }, { "affs": [ 7 ], "name": "Joanita Kirikumwino" }, { "affs": [ 8 ], "name": "Alisen Ayitewala" }, { "affs": [ 9 ], "name": "Isaac Ssewanyana" }, { "affs": [ 10 ], "name": "John Ssenkusu" }, { "name": "Robert Opoka" }, { "name": "Feiko O. ter Kuile" }, { "name": "Kamija S. Phiri" }, { "name": "Bjarne Robberstad" }, { "name": "Richard Idro" } ], "bibtex": "https://research.draconitic.com/paper/162jfngbng669.bib", "cited_by": 0, "doi": "10.1371/journal.pone.0340838", "fulltext_url": null, "id": "162jfngbng669", "issns": [ "1932-6203" ], "landing_url": "https://doi.org/10.1371/journal.pone.0340838", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2739|Malaria Research and Control" ], [ "plos", "/Biology and life sciences/Developmental biology/Microbial growth and development/Bacterial growth" ], [ "plos", "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Bacterial pathogens/Escherichia coli" ], [ "plos", "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Bacterial pathogens/Klebsiella/Klebsiella pneumoniae" ], [ "plos", "/Biology and life sciences/Microbiology/Microbial control/Antimicrobial resistance" ], [ "plos", "/Biology and life sciences/Microbiology/Microbial control/Antimicrobial resistance/Antibiotic resistance" ], [ "plos", "/Biology and life sciences/Microbiology/Microbial physiology/Microbial growth and development/Bacterial growth" ], [ "plos", "/Biology and life sciences/Organisms/Bacteria/Enterobacteriaceae/Escherichia/Escherichia coli" ], [ "plos", "/Biology and life sciences/Organisms/Bacteria/Gut bacteria/Escherichia/Escherichia coli" ], [ "plos", "/Biology and life sciences/Organisms/Bacteria/Klebsiella/Klebsiella pneumoniae" ], [ "plos", "/Medicine and health sciences/Medical conditions/Infectious diseases/Bacterial diseases" ], [ "plos", "/Medicine and health sciences/Medical conditions/Parasitic diseases/Malaria" ], [ "plos", "/Medicine and health sciences/Medical conditions/Tropical diseases/Malaria" ], [ "plos", "/Medicine and health sciences/Oncology/Cancer treatment/Chemoprevention" ], [ "plos", "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Bacterial pathogens/Escherichia coli" ], [ "plos", "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Bacterial pathogens/Klebsiella/Klebsiella pneumoniae" ], [ "plos", "/Medicine and health sciences/Pharmacology/Antimicrobial resistance" ], [ "plos", "/Medicine and health sciences/Pharmacology/Antimicrobial resistance/Antibiotic resistance" ], [ "plos", "/Research and analysis methods/Animal studies/Experimental organism systems/Model organisms/Escherichia coli" ], [ "plos", "/Research and analysis methods/Animal studies/Experimental organism systems/Prokaryotic models/Escherichia coli" ], [ "plos", "/Research and analysis methods/Model organisms/Escherichia coli" ] ], "openalex": "W7222330142", "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0340838&type=printable", "pmcid": null, "pmid": null, "published": "2026-10-15", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/162jfngbng669.ris", "sources": [ { "first_seen": "2026-10-30T12:17:23Z", "native_id": "10.1371/journal.pone.0340838", "source": "plos", "url": "https://doi.org/10.1371/journal.pone.0340838" } ], "subjects": [ { "field": "biology", "origin": "plos:microbiology", "subfield": "microbiology" } ], "title": "Bacterial infections and antibiotic susceptibility in children with sickle-cell anemia on malaria chemoprevention using Dihydroartemisinin-piperaquine (DP) or Sulfadoxine-pyrimethamine (SP) in Uganda", "title_text": "Bacterial infections and antibiotic susceptibility in children with sickle-cell anemia on malaria chemoprevention using Dihydroartemisinin-piperaquine (DP) or Sulfadoxine-pyrimethamine (SP) in Uganda", "type": "peer-reviewed", "updated_at": "2026-10-30T12:17:23Z", "url": "https://research.draconitic.com/paper/162jfngbng669", "venue": "PLOS One", "versions": [] }