1
|
Yamba K, Mudenda S, Mpabalwani E, Mainda G, Mukuma M, Samutela MT, Lukwesa C, Chizimu J, Kaluba CK, Mutalange M, Chilengi R, Muma JB. Antibiotic prescribing patterns and carriage of antibiotic-resistant Escherichia coli and Enterococcus species in healthy individuals from selected communities in Lusaka and Ndola districts, Zambia. JAC Antimicrob Resist 2024; 6:dlae027. [PMID: 38449515 PMCID: PMC10914442 DOI: 10.1093/jacamr/dlae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/06/2024] [Indexed: 03/08/2024] Open
Abstract
Objectives This study assessed antibiotic prescribing patterns in primary healthcare facilities and antimicrobial resistance (AMR) profiles of commensal Escherichia coli and enterococci isolated from pregnant women and children under 5 years of age. Materials and methods This cross-sectional study was conducted in Lusaka and Ndola districts of Zambia. Prescription pattern data were obtained from hospital pharmacies. Identification and antimicrobial susceptibility profiles of E. coli and enterococci were determined by conventional methods, while confirmation of both pathogens and AMR genes were determined by PCR. Data were analysed using WHONET and SPSS version 25.0. Results Most prescribed antibiotics at the primary healthcare facilities belonged to the Access group of the WHO Access, Watch and Reserve (AWaRe) classification. All the primary healthcare facilities adhered to the AWaRe framework of ≥60% prescribed antibiotics belonging to the Access group. However, resistance was highest in the Access group of antibiotics. E. coli resistance to ampicillin ranged from 71% to 77% and to co-trimoxazole from 74% to 80%, while enterococcal resistance to tetracycline was 59%-64%. MDR was highest in E. coli (75%) isolates, while XDR was highest in enterococcal isolates (97%). The identified AMR genes in E. coli included blaCTX-M, sul2 and qnrA, while those of enterococci included erm(B), erm(C) and erm(A). Conclusions Resistance was highest in the prescribed WHO Access group of antibiotics. These findings highlight the need to use local susceptibility data to formulate country-specific treatment guidelines in line with WHO AWaRe classification and enforce regulations that prohibit easy access to antibiotics.
Collapse
Affiliation(s)
- Kaunda Yamba
- Department of Pathology & Microbiology, University Teaching Hospitals, Lusaka, Zambia
- Department of Disease Control University of Zambia, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
- Antimicrobial Resistance Cluster, Zambia National Public Health Institute, Lusaka, Zambia
| | - Steward Mudenda
- Department of Disease Control University of Zambia, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Evans Mpabalwani
- Department of Paediatrics & Child Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Geoffrey Mainda
- Food and Agriculture Organization (FAO) of the United Nations, House No. 5, Chaholi, Off Addis Ababa Drive, Lusaka, Zambia
- Department of Veterinary Services Central Veterinary Research Institute (CVRI), Ministry of Fisheries and Livestock, Lusaka, Zambia
| | - Mercy Mukuma
- Department of Food Science, School of Agricultural Sciences and Nutrition, University of Zambia, Lusaka, Zambia
| | - Mulemba Tillika Samutela
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Chileshe Lukwesa
- Department of Pathology & Microbiology, University Teaching Hospitals, Lusaka, Zambia
| | - Joseph Chizimu
- Antimicrobial Resistance Cluster, Zambia National Public Health Institute, Lusaka, Zambia
| | - Ciluvya Kavimba Kaluba
- Department of Disease Control University of Zambia, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Matenge Mutalange
- Department of Disease Control University of Zambia, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
- Department of Pathology and Microbiology, School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
| | - Roma Chilengi
- Zambia National Public Health Institute, Ministry of Health, Lusaka, Zambia
| | - John Bwalya Muma
- Department of Disease Control University of Zambia, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| |
Collapse
|
2
|
Amato HK, Loayza F, Salinas L, Paredes D, Garcia D, Sarzosa S, Saraiva-Garcia C, Johnson TJ, Pickering AJ, Riley LW, Trueba G, Graham JP. Risk factors for extended-spectrum beta-lactamase (ESBL)-producing E. coli carriage among children in a food animal-producing region of Ecuador: A repeated measures observational study. PLoS Med 2023; 20:e1004299. [PMID: 37831716 PMCID: PMC10621961 DOI: 10.1371/journal.pmed.1004299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/02/2023] [Accepted: 09/15/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The spread of antibiotic-resistant bacteria may be driven by human-animal-environment interactions, especially in regions with limited restrictions on antibiotic use, widespread food animal production, and free-roaming domestic animals. In this study, we aimed to identify risk factors related to commercial food animal production, small-scale or "backyard" food animal production, domestic animal ownership, and practices related to animal handling, waste disposal, and antibiotic use in Ecuadorian communities. METHODS AND FINDINGS We conducted a repeated measures study from 2018 to 2021 in 7 semirural parishes of Quito, Ecuador to identify determinants of third-generation cephalosporin-resistant E. coli (3GCR-EC) and extended-spectrum beta-lactamase E. coli (ESBL-EC) in children. We collected 1,699 fecal samples from 600 children and 1,871 domestic animal fecal samples from 376 of the same households at up to 5 time points per household over the 3-year study period. We used multivariable log-binomial regression models to estimate relative risks (RR) of 3GCR-EC and ESBL-EC carriage, adjusting for child sex and age, caregiver education, household wealth, and recent child antibiotic use. Risk factors for 3GCR-EC included living within 5 km of more than 5 commercial food animal operations (RR: 1.26; 95% confidence interval (CI): 1.10, 1.45; p-value: 0.001), household pig ownership (RR: 1.23; 95% CI: 1.02, 1.48; p-value: 0.030) and child pet contact (RR: 1.23; 95% CI: 1.09, 1.39; p-value: 0.001). Risk factors for ESBL-EC were dog ownership (RR: 1.35; 95% CI: 1.00, 1.83; p-value: 0.053), child pet contact (RR: 1.54; 95% CI: 1.10, 2.16; p-value: 0.012), and placing animal feces on household land/crops (RR: 1.63; 95% CI: 1.09, 2.46; p-value: 0.019). The primary limitations of this study are the use of proxy and self-reported exposure measures and the use of a single beta-lactamase drug (ceftazidime with clavulanic acid) in combination disk diffusion tests for ESBL confirmation, potentially underestimating phenotypic ESBL production among cephalosporin-resistant E. coli isolates. To improve ESBL determination, it is recommended to use 2 combination disk diffusion tests (ceftazidime with clavulanic acid and cefotaxime with clavulanic acid) for ESBL confirmatory testing. Future studies should also characterize transmission pathways by assessing antibiotic resistance in commercial food animals and environmental reservoirs. CONCLUSIONS In this study, we observed an increase in enteric colonization of antibiotic-resistant bacteria among children with exposures to domestic animals and their waste in the household environment and children living in areas with a higher density of commercial food animal production operations.
Collapse
Affiliation(s)
- Heather K. Amato
- Environmental Health Sciences Division, School of Public Health, University of California, Berkeley, California, United States of America
| | - Fernanda Loayza
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Liseth Salinas
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Diana Paredes
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Daniela Garcia
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Soledad Sarzosa
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Carlos Saraiva-Garcia
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Timothy J. Johnson
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Saint Paul, Minnesota, United States of America
- Mid Central Research & Outreach Center, Willmar, Minnesota, United States of America
| | - Amy J. Pickering
- Department of Civil and Environmental Engineering, University of California, Berkeley, California, United States of America
- Blum Center for Developing Economies, University of California, Berkeley, California, United States of America
| | - Lee W. Riley
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California, United States of America
| | - Gabriel Trueba
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Jay P. Graham
- Environmental Health Sciences Division, School of Public Health, University of California, Berkeley, California, United States of America
| |
Collapse
|
3
|
Larson A, Haver S, Hattendorf J, Salmon-Mulanovich G, Riveros M, Verastegui H, Mäusezahl D, Hartinger S. Household-level risk factors for water contamination and antimicrobial resistance in drinking water among households with children under 5 in rural San Marcos, Cajamarca, Peru. One Health 2023; 16:100482. [PMID: 36655146 PMCID: PMC9841353 DOI: 10.1016/j.onehlt.2023.100482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023] Open
Abstract
Household water contamination at point of use depends on human, animal and environmental factors embodying all aspects of a One Health approach. This study investigated the association between household factors, the presence of thermotolerant coliform, and the presence of antibiotic resistant bacteria in drinking water among 314 households with children under 5 in Cajamarca, Peru. This study analysed data from a baseline sampling of a randomized controlled trial, including household surveys covering household water management and factors such as household animals, as well as microbiological data from samples collected from drinking water. Data were analysed using generalized linear models. Drinking water samples collected from narrow-mouthed containers were less likely to be contaminated than samples collected from the faucet (OR = 0.55, p = 0.030) or wide mouthed containers. The presence of thermotolerant coliform was associated with owning farm birds, which increased the proportion of contamination from 42.2% to 59.1% (OR = 1.98, p = 0.017) and with animal waste observed in the kitchen area, which increased the prevalence of contamination from 51.4% to 65.6% (OR = 1.80, p = 0.024). Resistance to any antibiotic was higher among pig owners at 60%, relative to non-pig owners at 36.4% (OR = 1.97, p = 0.012) as well as households with free-roaming animals in the kitchen area at 59.6% compared to households without free-roaming animals at 39.7% (OR = 2.24, p = 0.035). Recent child antibiotic use increased the prevalence of trimethoprim-sulfamethoxazole resistance among E. coli isolates to 22.3% relative to 16.7% (OR = 3.00, p = 0.037). Overall, these findings suggest that water storage in a secure container to protect from in-home contamination is likely to be important in providing safe drinking water at point of use. In addition, transmission of thermotolerant coliform and AMR between domestic animals and human drinking water supplies is likely. Further research should explore transmission pathways and methods to support safe drinking water access in multi-species households.
Collapse
Affiliation(s)
- A.J. Larson
- Universidad Peruana Cayetano Heredia, Lima, Peru,University of Washington, Seattle, United States,Swiss Tropical and Public Health Institute, Allschwil, Switzerland,University of Basel, Basel, Switzerland
| | - S. Haver
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland,University of Basel, Basel, Switzerland
| | - J. Hattendorf
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland,University of Basel, Basel, Switzerland
| | - G. Salmon-Mulanovich
- Universidad Peruana Cayetano Heredia, Lima, Peru,Institute for Nature, Earth and Energy at the Pontificia Universidad Católica del Perú, Lima, Peru
| | - M. Riveros
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - H. Verastegui
- Universidad Peruana Cayetano Heredia, Lima, Peru,Swiss Tropical and Public Health Institute, Allschwil, Switzerland,University of Basel, Basel, Switzerland
| | - D. Mäusezahl
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland,University of Basel, Basel, Switzerland
| | - S.M. Hartinger
- Universidad Peruana Cayetano Heredia, Lima, Peru,Swiss Tropical and Public Health Institute, Allschwil, Switzerland,University of Basel, Basel, Switzerland,Corresponding author at: Universidad Peruana Cayetano Heredia, Lima, Peru.
| |
Collapse
|
4
|
Swarthout JM, Chan EMG, Garcia D, Nadimpalli ML, Pickering AJ. Human Colonization with Antibiotic-Resistant Bacteria from Nonoccupational Exposure to Domesticated Animals in Low- and Middle-Income Countries: A Critical Review. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:14875-14890. [PMID: 35947446 DOI: 10.1021/acs.est.2c01494] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Data on community-acquired antibiotic-resistant bacterial infections are particularly sparse in low- and middle-income countries (LMICs). Limited surveillance and oversight of antibiotic use in food-producing animals, inadequate access to safe drinking water, and insufficient sanitation and hygiene infrastructure in LMICs could exacerbate the risk of zoonotic antibiotic resistance transmission. This critical review compiles evidence of zoonotic exchange of antibiotic-resistant bacteria (ARB) or antibiotic resistance genes (ARGs) within households and backyard farms in LMICs, as well as assesses transmission mechanisms, risk factors, and environmental transmission pathways. Overall, substantial evidence exists for exchange of antibiotic resistance between domesticated animals and in-contact humans. Whole bacteria transmission and horizontal gene transfer between humans and animals were demonstrated within and between households and backyard farms. Further, we identified water, soil, and animal food products as environmental transmission pathways for exchange of ARB and ARGs between animals and humans, although directionality of transmission is poorly understood. Herein we propose study designs, methods, and topical considerations for priority incorporation into future One Health research to inform effective interventions and policies to disrupt zoonotic antibiotic resistance exchange in low-income communities.
Collapse
Affiliation(s)
- Jenna M Swarthout
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts 02155, United States
| | - Elana M G Chan
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts 02155, United States
| | - Denise Garcia
- Department of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, California 94720, United States
| | - Maya L Nadimpalli
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts 02155, United States
- Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance, Tufts University, Boston, Massachusetts 02111, United States
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts 02155, United States
- Department of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, California 94720, United States
- Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance, Tufts University, Boston, Massachusetts 02111, United States
| |
Collapse
|
5
|
Gonzales-Rodríguez AO, Castillo Horna JI, Gonzales Escalante E. Identification of multidrug-resistant enterobacteriaceae in fecal samples from infants residing in Talara, Piura, Peru. Rev Peru Med Exp Salud Publica 2022; 39:456-462. [PMID: 36888808 PMCID: PMC11397669 DOI: 10.17843/rpmesp.2022.394.11870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/26/2022] [Indexed: 01/11/2023] Open
Abstract
La colonización fecal en lactantes por bacterias resistentes a los antimicrobianos es un potencial riesgo para futuras terapias antibióticas. Nuestro objetivo fue determinar la frecuencia y características sociodemográficas de lactantes portadores fecales de enterobacterias resistentes a ciprofloxacina (PFRC) y sus genes de resistencia asociados. Analizamos muestras fecales de 41 niños lactantes residentes en el distrito de Talara-Piura, Perú, en 2019. Evaluamos la presencia de 3 genes de resistencia a quinolonas: aac(6’)-Ib-cr, qnrB y oqxA y 2 de betalactamasas: blaCTX-M, blaPER-2.El 68% de lactantes fueron PFRC, Escherichia coli (83,3%) fue el más frecuente. El análisis genotípico detectó: oqxA (41,1%), qnrB (26,7%) y aac(6’)-Ib-cr (20%) y al gen blaCTX-M en el 93,3% de los aislados con betalactamasas. La elevada frecuencia de PFRC nos alertan sobre el potencial riesgo en la pérdida de utilidad de esta familia antibiótica en el área de estudio.
Collapse
Affiliation(s)
| | | | - Edgar Gonzales Escalante
- Facultad de Medicina Humana, Universidad de Piura, Lima, Perú
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Argentina
| |
Collapse
|
6
|
Castillo AK, Espinoza K, Chaves AF, Guibert F, Ruiz J, Pons MJ. Antibiotic susceptibility among non-clinical Escherichia coli as a marker of antibiotic pressure in Peru (2009-2019): one health approach. Heliyon 2022; 8:e10573. [PMID: 36119856 PMCID: PMC9479018 DOI: 10.1016/j.heliyon.2022.e10573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 06/21/2022] [Accepted: 09/02/2022] [Indexed: 12/04/2022] Open
Abstract
Objective Antimicrobial resistance is an increasing health problem worldwide with serious implications in global health. The overuse and misuse of antimicrobials has resulted in the spread of antimicrobial-resistant microorganisms in humans, animals and the environment. Surveillance of antimicrobial resistance provides important information contributing to understanding dissemination within these environments. These data are often unavailable in low- and middle-income countries, such as Peru. This review aimed to determine the levels of antimicrobial resistance in non-clinical Escherichia coli beyond the clinical setting in Peru. Methods We searched 2009-2019 literature in PUBMED, Google Scholar and local repositories. Results Thirty manuscripts including human, food, environmental, livestock, pets and/or wild animals' samples were found. The analysis showed high resistance levels to a variety of antimicrobial agents, with >90% of resistance for streptomycin and non-extended-spectrum cephalosporin in livestock and food. High levels of rifamycin resistance were also found in non-clinical samples from humans. In pets, resistance levels of 70->90% were detected for quinolones tetracycline and non-extended spectrum cephalosporins. The results suggest higher levels of antimicrobial resistance in captive than in free-ranging wild-animals. Finally, among environmental samples, 50-70% of resistance to non-extended-spectrum cephalosporin and streptomycin was found. Conclusions High levels of resistance, especially related to old antibacterial agents, such as streptomycin, 1st and 2nd generation cephalosporins, tetracyclines or first-generation quinolones were detected. Antimicrobial use and control measures are needed with a One Health approach to identify the main drivers of antimicrobial resistance due to interconnected human, animal and environmental habitats.
Collapse
Affiliation(s)
- Angie K. Castillo
- Laboratorio de Genética Molecular y Bioquímica, Universidad Científica Del Sur, Lima, Peru
| | - Kathya Espinoza
- Laboratorio de Genética Molecular y Bioquímica, Universidad Científica Del Sur, Lima, Peru
| | - Antony F. Chaves
- Laboratorio de Genética Molecular y Bioquímica, Universidad Científica Del Sur, Lima, Peru
| | - Fernando Guibert
- Laboratorio de Genética Molecular y Bioquímica, Universidad Científica Del Sur, Lima, Peru
| | - Joaquim Ruiz
- Laboratorio de Genética Molecular y Bioquímica, Universidad Científica Del Sur, Lima, Peru
| | - Maria J. Pons
- Laboratorio de Genética Molecular y Bioquímica, Universidad Científica Del Sur, Lima, Peru
| |
Collapse
|
7
|
Young CCW, Karmacharya D, Bista M, Sharma AN, Goldstein T, Mazet JAK, Johnson CK. Antibiotic resistance genes of public health importance in livestock and humans in an informal urban community in Nepal. Sci Rep 2022; 12:13808. [PMID: 35970981 PMCID: PMC9378709 DOI: 10.1038/s41598-022-14781-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 06/13/2022] [Indexed: 11/09/2022] Open
Abstract
Efforts to mitigate the increasing emergence of antimicrobial resistance (AMR) will benefit from a One Health perspective, as over half of animal antimicrobials are also considered medically important in humans, and AMR can be maintained in the environment. This is especially pertinent to low- and middle-income countries and in community settings, where an estimated 80% of all antibiotics are used. This study features AMR genes found among humans, animals, and water at an urban informal settlement in Nepal with intensifying livestock production. We sampled humans, chickens, ducks, swine, and water clustered by household, as well as rodents and shrews near dwellings, concurrently in time in July 2017 in southeastern Kathmandu along the Manohara river. Real-time qualitative PCR was performed to screen for 88 genes. Our results characterize the animal-human-environmental interfaces related to the occurrence of specific resistance genes (blaSHV-1 (SHV(238G240E) strain), QnrS, ermC, tetA, tetB, aacC2, aadA1) associated with antibiotics of global health importance that comprise several drug classes, including aminoglycosides, beta-lactams, tetracyclines, macrolides, and fluoroquinolones. By characterizing risk factors across AMR genes of public health importance, this research highlights potential transmission pathways for further investigation and provides prioritization of community-based prevention and intervention efforts for disrupting AMR transmission of critically important antibiotics used in both humans and animals in Nepal.
Collapse
Affiliation(s)
- Cristin C W Young
- EpiCenter for Disease Dynamics, School of Veterinary Medicine, University of California, Davis, 1089 Veterinary Medicine Drive, Davis, CA, 95616, USA
| | - Dibesh Karmacharya
- Center for Molecular Dynamics, Nepal (CMDN), Thapathali Road 11, Kathmandu, 44600, Nepal.
| | | | - Ajay N Sharma
- Center for Molecular Dynamics, Nepal (CMDN), Thapathali Road 11, Kathmandu, 44600, Nepal
| | - Tracey Goldstein
- One Health Institute, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Jonna A K Mazet
- One Health Institute, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Christine K Johnson
- EpiCenter for Disease Dynamics, School of Veterinary Medicine, University of California, Davis, 1089 Veterinary Medicine Drive, Davis, CA, 95616, USA.
| |
Collapse
|
8
|
Medina-Pizzali ML, Hartinger SM, Salmon-Mulanovich G, Larson A, Riveros M, Mäusezahl D. Antimicrobial Resistance in Rural Settings in Latin America: A Scoping Review with a One Health Lens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189837. [PMID: 34574760 PMCID: PMC8464982 DOI: 10.3390/ijerph18189837] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 12/18/2022]
Abstract
Antimicrobial resistance (AMR) in rural Latin America is not fully understood. The transmission pathways are partially known since research predominantly focuses on the urban hospital setting. The contribution to AMR from environmental factors is usually only mentioned in large-scale animal production. To understand the state of the literature on AMR in rural LA, we carried out a scoping review using the One Health (OH) perspective. OH recognises the concomitant contributions and interconnectedness of humans, animal, and the environment, thus, we used the OH perspective to select those articles adopting a holistic view of the problem. We searched original articles in English, Spanish, and Portuguese in four peer-reviewed databases and included 21 publications in the analysis. We charted data on bibliometrics, design, data collection sources, and instruments. We identified the human, animal, and environmental contributions to AMR in rural locations, and information gaps on AMR transmission routes and AMR drivers. Intensive and non-intensive animal production systems and agricultural practices were the most frequently found human contributions to AMR. Poultry, swine, cattle, and fish were the most frequent livestock mentioned as sources of AMR bacteria. Animal carriage and/or transfer of AMR determinants or bacteria was recognised as the primary contribution of livestock to the problem, while water, soil, and farming were predominant environmental contributions. We found that only 1 article out of 21 considered the OH approach as a framework for their sampling scheme, whereas 5 out 21 discussed all the three OH components. There were hardly any descriptions of humans or human waste as reservoirs for AMR in rural locations, and rural health centres or hospitals and wildlife were not represented. No studies identified mining as an anthropogenic activity driving AMR. More OH-oriented studies, with emphasis on molecular approaches—for identification and comparison of AMR genes—are sorely needed to understand better the existence of a network of interconnected transmission routes in rural Latin America and provide efficient strategies to prevent further AMR emergence.
Collapse
Affiliation(s)
- Maria Luisa Medina-Pizzali
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 31, Peru; (M.L.M.-P.); (G.S.-M.); (A.L.)
| | - Stella M. Hartinger
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 31, Peru; (M.L.M.-P.); (G.S.-M.); (A.L.)
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4057 Basel, Switzerland;
- Swiss Tropical and Public Health Institute, University of Basel, Petersplatz 1, 4051 Basel, Switzerland
- Correspondence:
| | - Gabriela Salmon-Mulanovich
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 31, Peru; (M.L.M.-P.); (G.S.-M.); (A.L.)
- Institute for Earth, Nature and Energy at Pontificia Universidad Catolica del Peru, Av. Universitaria 1801, San Miguel, Lima 32, Peru
| | - Anika Larson
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 31, Peru; (M.L.M.-P.); (G.S.-M.); (A.L.)
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA
| | - Maribel Riveros
- School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 31, Peru;
| | - Daniel Mäusezahl
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4057 Basel, Switzerland;
- Swiss Tropical and Public Health Institute, University of Basel, Petersplatz 1, 4051 Basel, Switzerland
| |
Collapse
|
9
|
Antimicrobial Resistance in Humans, Animals, Water and Household Environs in Rural Andean Peru: Exploring Dissemination Pathways through the One Health Lens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094604. [PMID: 33925280 PMCID: PMC8123641 DOI: 10.3390/ijerph18094604] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 01/26/2023]
Abstract
Antimicrobial resistance (AMR) is a global public health threat, especially for low and middle-income countries (LMIC) where the threat has not been fully identified. Our study aims to describe E. coli AMR in rural communities to expand our knowledge on AMR bacterial contamination. Specifically, we aim to identify and describe potential dissemination routes of AMR-carrying bacteria in humans (children’s stools), community water sources (reservoirs and household sources), household environments (yard soil) and domestic animals of subsistence farmers in rural Andean areas. Our cross-sectional study was conducted in rural households in the region of Cajamarca, Peru. A total of 266 samples were collected. Thirty-four point six percent of reservoir water and 45% of household water source samples were positive for thermotolerant coliforms. Of the reservoir water samples, 92.8% were positive for E. coli, and 30.8% displayed resistance to at least one antibiotic, with the highest resistance to tetracycline. E. coli was found in 57.1% of the household water sources, 18.6% of these isolates were multidrug-resistant, and displayed the highest resistance to tetracycline (31.3%). Among samples from the children’s drinking water source, 32.5% were positive for thermotolerant coliforms, and 57.1% of them were E. coli. One third of E. coli isolates were multidrug-resistant and displayed the highest AMR to tetracycline (41.6%) and ampicillin (25%). Thermotolerant coliforms were found in all the soil samples, 43.3% of the isolates were positive for E. coli, 34.3% of the E. coli isolates displayed AMR to at least one antibiotic, and displayed the highest AMR to tetracycline (25.7%). We determined thermotolerant coliforms in 97.5% of the child feces samples; 45.3% of them were E. coli, 15.9% displayed multidrug resistance, and displayed the highest resistance to ampicillin (34.1%). We identified thermotolerant coliforms in 67.5% of the animal feces samples. Of those, 38.7% were E. coli, and 37.7% were resistant to at least one antibiotic. For all the samples, the prevalence of resistance to at least one antibiotic in the E. coli and Klebsiella spp. isolates was almost 43% and the prevalence of MDR in the same isolates was nearly 9%, yet the latter nearly doubled (15.9%) in children’s stools. Our results provide preliminary evidence for critical pathways and the interconnectedness of animal, human and environmental transmission but molecular analysis is needed to track dissemination routes properly.
Collapse
|
10
|
Murray M, Salvatierra G, Dávila-Barclay A, Ayzanoa B, Castillo-Vilcahuaman C, Huang M, Pajuelo MJ, Lescano AG, Cabrera L, Calderón M, Berg DE, Gilman RH, Tsukayama P. Market Chickens as a Source of Antibiotic-Resistant Escherichia coli in a Peri-Urban Community in Lima, Peru. Front Microbiol 2021; 12:635871. [PMID: 33737922 PMCID: PMC7961087 DOI: 10.3389/fmicb.2021.635871] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/02/2021] [Indexed: 12/17/2022] Open
Abstract
The widespread and poorly regulated use of antibiotics in animal production in low- and middle-income countries (LMICs) is increasingly associated with the emergence and dissemination of antibiotic resistance genes (ARGs) in retail animal products. Here, we compared Escherichia coli from chickens and humans with varying levels of exposure to chicken meat in a low-income community in the southern outskirts of Lima, Peru. We hypothesize that current practices in local poultry production result in highly resistant commensal bacteria in chickens that can potentially colonize the human gut. E. coli was isolated from cloacal swabs of non-organic (n = 41) and organic chickens (n = 20), as well as from stools of market chicken vendors (n = 23), non-vendors (n = 48), and babies (n = 60). 315 E. coli isolates from humans (n = 150) and chickens (n = 165) were identified, with chickens showing higher rates of multidrug-resistant and extended-spectrum beta-lactamase phenotypes. Non-organic chicken isolates were more resistant to most antibiotics tested than human isolates, while organic chicken isolates were susceptible to most antibiotics. Whole-genome sequencing of 118 isolates identified shared phylogroups between human and animal populations and 604 ARG hits across genomes. Resistance to florfenicol (an antibiotic commonly used as a growth promoter in poultry but not approved for human use) was higher in chicken vendors compared to other human groups. Isolates from non-organic chickens contained genes conferring resistance to clinically relevant antibiotics, including mcr-1 for colistin resistance, blaCTX-M ESBLs, and blaKPC-3 carbapenemase. Our findings suggest that E. coli strains from market chickens are a potential source of ARGs that can be transmitted to human commensals.
Collapse
Affiliation(s)
- Matthew Murray
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Guillermo Salvatierra
- Laboratorio de Genómica Microbiana, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru.,Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Alejandra Dávila-Barclay
- Laboratorio de Genómica Microbiana, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Brenda Ayzanoa
- Laboratorio de Genómica Microbiana, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Camila Castillo-Vilcahuaman
- Laboratorio de Genómica Microbiana, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Michelle Huang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Mónica J Pajuelo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Laboratorio de Microbiología Molecular, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Andrés G Lescano
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Maritza Calderón
- Laboratorios de Enfermedades Infecciosas, Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Douglas E Berg
- Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Robert H Gilman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Pablo Tsukayama
- Laboratorio de Genómica Microbiana, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru.,Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.,Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.,Wellcome Sanger Institute, Hinxton, United Kingdom
| |
Collapse
|
11
|
Nji E, Kazibwe J, Hambridge T, Joko CA, Larbi AA, Damptey LAO, Nkansa-Gyamfi NA, Stålsby Lundborg C, Lien LTQ. High prevalence of antibiotic resistance in commensal Escherichia coli from healthy human sources in community settings. Sci Rep 2021; 11:3372. [PMID: 33564047 PMCID: PMC7873077 DOI: 10.1038/s41598-021-82693-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 01/21/2021] [Indexed: 01/30/2023] Open
Abstract
Antibiotic resistance is a global health crisis that requires urgent action to stop its spread. To counteract the spread of antibiotic resistance, we must improve our understanding of the origin and spread of resistant bacteria in both community and healthcare settings. Unfortunately, little attention is being given to contain the spread of antibiotic resistance in community settings (i.e., locations outside of a hospital inpatient, acute care setting, or a hospital clinic setting), despite some studies have consistently reported a high prevalence of antibiotic resistance in the community settings. This study aimed to investigate the prevalence of antibiotic resistance in commensal Escherichia coli isolates from healthy humans in community settings in LMICs. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we synthesized studies conducted from 1989 to May 2020. A total of 9363 articles were obtained from the search and prevalence data were extracted from 33 articles and pooled together. This gave a pooled prevalence of antibiotic resistance (top ten antibiotics commonly prescribed in LMICs) in commensal E. coli isolates from human sources in community settings in LMICs of: ampicillin (72% of 13,531 isolates, 95% CI: 65-79), cefotaxime (27% of 6700 isolates, 95% CI: 12-44), chloramphenicol (45% of 7012 isolates, 95% CI: 35-53), ciprofloxacin (17% of 10,618 isolates, 95% CI: 11-25), co-trimoxazole (63% of 10,561 isolates, 95% CI: 52-73), nalidixic acid (30% of 9819 isolates, 95% CI: 21-40), oxytetracycline (78% of 1451 isolates, 95% CI: 65-88), streptomycin (58% of 3831 isolates, 95% CI: 44-72), tetracycline (67% of 11,847 isolates, 95% CI: 59-74), and trimethoprim (67% of 3265 isolates, 95% CI: 59-75). Here, we provided an appraisal of the evidence of the high prevalence of antibiotic resistance by commensal E. coli in community settings in LMICs. Our findings will have important ramifications for public health policy design to contain the spread of antibiotic resistance in community settings. Indeed, commensal E. coli is the main reservoir for spreading antibiotic resistance to other pathogenic enteric bacteria via mobile genetic elements.
Collapse
Affiliation(s)
- Emmanuel Nji
- BioStruct-Africa, Vårby, 143 43, Stockholm, Sweden.
| | - Joseph Kazibwe
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Thomas Hambridge
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
| | - Carolyn Alia Joko
- BioStruct-Africa, Vårby, 143 43, Stockholm, Sweden
- Faculty of Science and Engineering, Åbo Akademi University, Turku, Finland
| | - Amma Aboagyewa Larbi
- BioStruct-Africa, Vårby, 143 43, Stockholm, Sweden
- Department of Biochemistry and Biotechnology, College of Science, Kwame Nkrumah University of Science and Technology, PMB, Kumasi, Ghana
| | | | | | - Cecilia Stålsby Lundborg
- Health Systems and Policy (HSP): Improving the Use of Medicines, Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, 17177, Stockholm, Sweden
| | - La Thi Quynh Lien
- Department of Pharmaceutical Management and Pharmaco-Economics, Hanoi University of Pharmacy, 13-15 Le Thanh Tong, Hoan Kiem District, Hanoi, 110403, Vietnam
| |
Collapse
|
12
|
Salinas L, Loayza F, Cárdenas P, Saraiva C, Johnson TJ, Amato H, Graham JP, Trueba G. Environmental Spread of Extended Spectrum Beta-Lactamase (ESBL) Producing Escherichia coli and ESBL Genes among Children and Domestic Animals in Ecuador. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:27007. [PMID: 33617318 PMCID: PMC7899495 DOI: 10.1289/ehp7729] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 05/24/2023]
Abstract
BACKGROUND There is a significant gap in our understanding of the sources of multidrug-resistant bacteria and resistance genes in community settings where human-animal interfaces exist. OBJECTIVES This study characterized the relationship of third-generation cephalosporin-resistant Escherichia coli (3GCR-EC) isolated from animal feces in the environment and child feces based on phenotypic antimicrobial resistance (AMR) and whole genome sequencing (WGS). METHODS We examined 3GCR-EC isolated from environmental fecal samples of domestic animals and child fecal samples in Ecuador. We analyzed phenotypic and genotypic AMR, as well as clonal relationships (CRs) based on pairwise single-nucleotide polymorphisms (SNPs) analysis of 3GCR-EC core genomes. CRs were defined as isolates with fewer than 100 different SNPs. RESULTS A total of 264 3GCR-EC isolates from children (n=21), dogs (n=20), and chickens (n=18) living in the same region of Quito, Ecuador, were identified. We detected 16 CRs total, which were found between 7 children and 5 domestic animals (5 CRs) and between 19 domestic animals (11 CRs). We observed that several clonally related 3GCR-EC isolates had acquired different plasmids and AMR genes. Most CRs were observed in different homes (n=14) at relatively large distances. Isolates from children and domestic animals shared the same blaCTX-M allelic variants, and the most prevalent were blaCTX-M-55 and blaCTX-M-65, which were found in isolates from children, dogs, and chickens. DISCUSSION This study provides evidence of highly dynamic horizontal transfer of AMR genes and mobile genetic elements (MGEs) in the E. coli community and shows that some 3GCR-EC and (extended-spectrum β-lactamase) ESBL genes may have moved relatively large distances among domestic animals and children in semirural communities near Quito, Ecuador. Child-animal contact and the presence of domestic animal feces in the environment potentially serve as important sources of drug-resistant bacteria and ESBL genes. https://doi.org/10.1289/EHP7729.
Collapse
Affiliation(s)
- Liseth Salinas
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador
| | - Fernanda Loayza
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador
| | - Paúl Cárdenas
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador
| | - Carlos Saraiva
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador
| | - Timothy J. Johnson
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Saint Paul, Minnesota, USA
- Mid Central Research & Outreach Center, Willmar, Minnesota, USA
| | - Heather Amato
- Environmental Health Sciences Division, University of California, Berkeley, California, USA
| | - Jay P. Graham
- Environmental Health Sciences Division, University of California, Berkeley, California, USA
| | - Gabriel Trueba
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador
| |
Collapse
|
13
|
Gaire TN, Scott HM, Sellers L, Nagaraja TG, Volkova VV. Age Dependence of Antimicrobial Resistance Among Fecal Bacteria in Animals: A Scoping Review. Front Vet Sci 2021; 7:622495. [PMID: 33575279 PMCID: PMC7870994 DOI: 10.3389/fvets.2020.622495] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/11/2020] [Indexed: 01/23/2023] Open
Abstract
Introduction: A phenomenon of decreasing antimicrobial resistance (AMR) among fecal bacteria as food animals age has been noted in multiple field studies. We conducted a scoping review to summarize the extent, range, and nature of research activity and the data for the following question: "does AMR among enteric/fecal bacteria predictably shift as animals get older?". Methods: This review followed a scoping review methodology framework. Pertinent literature published up until November 2018 for all animals (except humans) was retrieved using keyword searches in two online databases, namely, PubMed® and the Web of Science™ Core Collection, without filtering publication date, geographic location, or language. Data were extracted from the included studies, summarized, and plotted. Study quality was also assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) guidelines for all included papers. Results: The publications with detailed relevant data (n = 62) in food animals, poultry, and dogs were identified. These included longitudinal studies (n = 32), cross-sectional studies of different age groups within one food animal production system or small-animal catchment area (n = 16), and experimental or diet trials (n = 14). A decline in host-level prevalence and/or within-host abundance of AMR among fecal bacteria in production beef, dairy cattle, and swine was reported in nearly two-thirds (65%) of the identified studies in different geographic locations from the 1970's to 2018. Mixed results, with AMR abundance among fecal bacteria either increasing or decreasing with age, have been reported in poultry (broiler chicken, layer, and grow-out turkey) and dogs. Conclusions: Quantitative synthesis of the data suggests that the age-dependent AMR phenomenon in cattle and swine is observed irrespective of geographic location and specific production practices. It is unclear whether the phenomenon predates or is related to antimicrobial drug use. However, almost 50% of the identified studies predate recent changes in antimicrobial drug use policy and regulations in food animals in the United States and elsewhere.
Collapse
Affiliation(s)
- Tara N Gaire
- Department of Diagnostic Medicine/Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS, United States
| | - Harvey Morgan Scott
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
| | - Laura Sellers
- Department of Diagnostic Medicine/Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS, United States
| | - T G Nagaraja
- Department of Diagnostic Medicine/Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS, United States
| | - Victoriya V Volkova
- Department of Diagnostic Medicine/Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS, United States
| |
Collapse
|
14
|
Omulo S, Lofgren ET, Lockwood S, Thumbi SM, Bigogo G, Ouma A, Verani JR, Juma B, Njenga MK, Kariuki S, McElwain TF, Palmer GH, Call DR. Carriage of antimicrobial-resistant bacteria in a high-density informal settlement in Kenya is associated with environmental risk-factors. Antimicrob Resist Infect Control 2021; 10:18. [PMID: 33482919 PMCID: PMC7821723 DOI: 10.1186/s13756-021-00886-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relationship between antibiotic use and antimicrobial resistance varies with cultural, socio-economic, and environmental factors. We examined these relationships in Kibera, an informal settlement in Nairobi-Kenya, characterized by high population density, high burden of respiratory disease and diarrhea. METHODS Two-hundred households were enrolled in a 5-month longitudinal study. One adult (≥ 18 years) and one child (≤ 5 years) participated per household. Biweekly interviews (n = 1516) that included questions on water, sanitation, hygiene, and antibiotic use in the previous two weeks were conducted, and 2341 stool, 2843 hand swabs and 1490 drinking water samples collected. Presumptive E. coli (n = 34,042) were isolated and tested for susceptibility to nine antibiotics. RESULTS Eighty percent of presumptive E. coli were resistant to ≥ 3 antibiotic classes. Stool isolates were resistant to trimethoprim (mean: 81%), sulfamethoxazole (80%), ampicillin (68%), streptomycin (60%) and tetracycline (55%). Ninety-seven households reported using an antibiotic in at least one visit over the study period for a total of 144 episodes and 190 antibiotic doses. Enrolled children had five times the number of episodes reported by enrolled adults (96 vs. 19). Multivariable linear mixed-effects models indicated that children eating soil from the household yard and the presence of informal hand-washing stations were associated with increased numbers of antimicrobial-resistant bacteria (counts increasing by 0·27-0·80 log10 and 0·22-0·51 log10 respectively, depending on the antibiotic tested). Rainy conditions were associated with reduced carriage of antimicrobial-resistant bacteria (1·19 to 3·26 log10 depending on the antibiotic tested). CONCLUSIONS Antibiotic use provided little explanatory power for the prevalence of antimicrobial resistance. Transmission of resistant bacteria in this setting through unsanitary living conditions likely overwhelms incremental changes in antibiotic use. Under such circumstances, sanitation, hygiene, and disease transmission are the limiting factors for reducing the prevalence of resistant bacteria.
Collapse
Affiliation(s)
- Sylvia Omulo
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA. .,Washington State University Global Health-Kenya, Nairobi, Kenya. .,Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
| | - Eric T Lofgren
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
| | - Svetlana Lockwood
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
| | - Samuel M Thumbi
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Washington State University Global Health-Kenya, Nairobi, Kenya.,Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Godfrey Bigogo
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Alice Ouma
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | | | - M Kariuki Njenga
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Washington State University Global Health-Kenya, Nairobi, Kenya
| | - Samuel Kariuki
- Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Terry F McElwain
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Nelson Mandela African Institution for Science and Technology, Arusha, Tanzania
| | - Guy H Palmer
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Washington State University Global Health-Kenya, Nairobi, Kenya.,Nelson Mandela African Institution for Science and Technology, Arusha, Tanzania
| | - Douglas R Call
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Washington State University Global Health-Kenya, Nairobi, Kenya.,Nelson Mandela African Institution for Science and Technology, Arusha, Tanzania
| |
Collapse
|
15
|
Marusinec R, Kurowski KM, Amato HK, Saraiva-Garcia C, Loayza F, Salinas L, Trueba G, Graham JP. Caretaker knowledge, attitudes, and practices (KAP) and carriage of extended-spectrum beta-lactamase-producing E. coli (ESBL-EC) in children in Quito, Ecuador. Antimicrob Resist Infect Control 2021; 10:2. [PMID: 33407927 PMCID: PMC7789729 DOI: 10.1186/s13756-020-00867-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/04/2020] [Indexed: 12/11/2022] Open
Abstract
Background The rapid spread of extended-spectrum beta-lactamase-producing E. coli (ESBL-EC) is an urgent global health threat. We examined child caretaker knowledge, attitudes, and practices (KAP) towards proper antimicrobial agent use and whether certain KAP were associated with ESBL-EC colonization of their children. Methods Child caretakers living in semi-rural neighborhoods in peri-urban Quito, Ecuador were visited and surveyed about their KAP towards antibiotics. Fecal samples from one child (less than 5 years of age) per household were collected at two time points between July 2018 and May 2019 and screened for ESBL-EC. A repeated measures analysis with logistic regression was used to assess the relationship between KAP levels and child colonization with ESBL-EC. Results We analyzed 740 stool samples from 444 children living in households representing a range of environmental conditions. Of 374 children who provided fecal samples at the first household visit, 44 children were colonized with ESBL-EC (11.8%) and 161 were colonized with multidrug-resistant E. coli (43%). The prevalences of ESBL-EC and multidrug-resistant E. coli were similar at the second visit (11.2% and 41.3%, respectively; N = 366). Only 8% of caretakers knew that antibiotics killed bacteria but not viruses, and over a third reported that they “always” give their children antibiotics when the child’s throat hurts (35%). Few associations were observed between KAP variables and ESBL-EC carriage among children. The odds of ESBL-EC carriage were 2.17 times greater (95% CI: 1.18–3.99) among children whose caregivers incorrectly stated that antibiotics do not kill bacteria compared to children whose caregivers correctly stated that antibiotics kill bacteria. Children from households where the caretaker answered the question “When your child’s throat hurts, do you give them antibiotics?” with “sometimes” had lower odds of ESBL-EC carriage than those with a caretaker response of “never” (OR 0.48, 95% CI 0.27–0.87). Conclusion Caregivers in our study population generally demonstrated low knowledge regarding appropriate use of antibiotics. Our findings suggest that misinformation about the types of infections (i.e. bacterial or viral) antibiotics should be used for may be associated with elevated odds of carriage of ESBL-EC. Understanding that using antibiotics is appropriate to treat infections some of the time may reduce the odds of ESBL-EC carriage. Overall, however, KAP measures of appropriate use of antibiotics were not strongly associated with ESBL-EC carriage. Other individual- and community-level environmental factors may overshadow the effect of KAP on ESBL-EC colonization. Intervention studies are needed to assess the true effect of improving KAP on laboratory-confirmed carriage of antimicrobial resistant bacteria, and should consider community-level studies for more effective management.
Collapse
Affiliation(s)
- Rachel Marusinec
- Berkeley School of Public Health, University of California, Berkeley, CA, USA
| | - Kathleen M Kurowski
- Berkeley School of Public Health, University of California, Berkeley, CA, USA
| | - Heather K Amato
- Berkeley School of Public Health, University of California, Berkeley, CA, USA
| | - Carlos Saraiva-Garcia
- Microbiology Institute, Colegio de Ciencias Biologicas Y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Fernanda Loayza
- Microbiology Institute, Colegio de Ciencias Biologicas Y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Liseth Salinas
- Microbiology Institute, Colegio de Ciencias Biologicas Y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Gabriel Trueba
- Microbiology Institute, Colegio de Ciencias Biologicas Y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Jay P Graham
- Berkeley School of Public Health, University of California, Berkeley, CA, USA.
| |
Collapse
|
16
|
Abstract
Antibiotic use is a key driver of antibiotic resistance. Understanding the quantitative association between antibiotic use and resulting resistance is important for predicting future rates of antibiotic resistance and for designing antibiotic stewardship policy. However, the use-resistance association is complicated by "spillover," in which one population's level of antibiotic use affects another population's level of resistance via the transmission of bacteria between those populations. Spillover is known to have effects at the level of families and hospitals, but it is unclear if spillover is relevant at larger scales. We used mathematical modeling and analysis of observational data to address this question. First, we used dynamical models of antibiotic resistance to predict the effects of spillover. Whereas populations completely isolated from one another do not experience any spillover, we found that if even 1% of interactions are between populations, then spillover may have large consequences: The effect of a change in antibiotic use in one population on antibiotic resistance in that population could be reduced by as much as 50%. Then, we quantified spillover in observational antibiotic use and resistance data from US states and European countries for three pathogen-antibiotic combinations, finding that increased interactions between populations were associated with smaller differences in antibiotic resistance between those populations. Thus, spillover may have an important impact at the level of states and countries, which has ramifications for predicting the future of antibiotic resistance, designing antibiotic resistance stewardship policy, and interpreting stewardship interventions.
Collapse
Affiliation(s)
- Scott W Olesen
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA 02115
| | - Marc Lipsitch
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA 02115
- Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, MA 02115
| | - Yonatan H Grad
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA 02115;
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115
| |
Collapse
|
17
|
Bloch EM, Coles CL, Kasubi M, Weaver J, Mrango Z, Munoz B, Lietman TM, West SK. Biannual Treatment of Preschool Children with Single Dose Azithromycin to Reduce Mortality: Impact on Azithromycin Resistance in the MORDOR Trial in Tanzania. Am J Trop Med Hyg 2020; 103:1301-1307. [PMID: 32067633 PMCID: PMC7470586 DOI: 10.4269/ajtmh.19-0086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance study showed that administration of biannual, single-dose azithromycin to preschool children reduces mortality. We sought to evaluate its impact on azithromycin resistance. Thirty randomly selected communities in Kilosa district, Tanzania, were randomized to receive 6-monthly single-dose azithromycin (∼20 mg/kg) versus placebo treatment of children aged 1–59 months. From each community, 40 children (aged 1–59 months) were randomly selected at baseline, 12 and 24 months. Isolation and resistance testing of Streptococcus pneumoniae and Escherichia coli were evaluated using nasopharyngeal and rectal swabs, respectively. The carriage prevalence and the proportion of azithromycin-resistant isolates were determined using disk diffusion. At baseline, the characteristics of the randomly selected children were similar by treatment arms. Both at baseline and in annual cross-sectional surveys, rates of S. pneumoniae and E. coli isolation between treatment arms were similar. The proportions of azithromycin-resistant S. pneumoniae isolates in the children in communities treated with azithromycin versus placebo at baseline, 12 months, and 24 months were 26.5% (18.1%; P = 0.26), 26.8% (16.5%; P = 0.29), and 13.4% (17.0%; P = 0.57), respectively. The proportions of azithromycin-resistant E. coli isolates at baseline, 12 months, and 24 months in the azithromycin (versus placebo) arms were 14.9% (18.9%; P = 0.16), 21.5% (16.6%; P = 0.10), and 14.9% (14.7%; P = 0.95), respectively. Over the 24 months, the mean treatment coverage for the azithromycin and placebo was 76.9% and 74.8%, respectively (P = 0.49). Biannual administration of single-dose azithromycin to children did not appear to result in excess azithromycin resistance in S. pneumoniae and E. coli isolates over 24 months of follow-up.
Collapse
Affiliation(s)
- Evan M Bloch
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Christian L Coles
- Infectious Disease Clinical Research Program, Uniformed University of the Health Sciences, Bethesda, Maryland
| | - Mabula Kasubi
- Department of Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jerusha Weaver
- Dana Center for Preventive Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Zakayo Mrango
- National Institute for Medical Research, Kilosa, Tanzania
| | - Beatriz Munoz
- Dana Center for Preventive Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Thomas M Lietman
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland
| |
Collapse
|
18
|
Hedman HD, Vasco KA, Zhang L. A Review of Antimicrobial Resistance in Poultry Farming within Low-Resource Settings. Animals (Basel) 2020; 10:E1264. [PMID: 32722312 PMCID: PMC7460429 DOI: 10.3390/ani10081264] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 12/28/2022] Open
Abstract
The emergence, spread, and persistence of antimicrobial resistance (AMR) remain a pressing global health issue. Animal husbandry, in particular poultry, makes up a substantial portion of the global antimicrobial use. Despite the growing body of research evaluating the AMR within industrial farming systems, there is a gap in understanding the emergence of bacterial resistance originating from poultry within resource-limited environments. As countries continue to transition from low- to middle income countries (LMICs), there will be an increased demand for quality sources of animal protein. Further promotion of intensive poultry farming could address issues of food security, but it may also increase risks of AMR exposure to poultry, other domestic animals, wildlife, and human populations. Given that intensively raised poultry can function as animal reservoirs for AMR, surveillance is needed to evaluate the impacts on humans, other animals, and the environment. Here, we provide a comprehensive review of poultry production within low-resource settings in order to inform future small-scale poultry farming development. Future research is needed in order to understand the full extent of the epidemiology and ecology of AMR in poultry within low-resource settings.
Collapse
Affiliation(s)
- Hayden D. Hedman
- Illinois Natural History Survey, Prairie Research Institute, University of Illinois Urbana-Champaign, Champaign, IL 61820, USA
| | - Karla A. Vasco
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI 48824, USA; (K.A.V.); (L.Z.)
| | - Lixin Zhang
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI 48824, USA; (K.A.V.); (L.Z.)
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI 48824, USA
| |
Collapse
|
19
|
Geographic mapping of Enterobacteriaceae with extended-spectrum β-lactamase (ESBL) phenotype in Pereira, Colombia. BMC Infect Dis 2020; 20:540. [PMID: 32703276 PMCID: PMC7379364 DOI: 10.1186/s12879-020-05267-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/16/2020] [Indexed: 12/23/2022] Open
Abstract
Background Antimicrobial resistance is an ecological and multicausal problem. Infections caused by extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-E) can be acquired and transmitted in the community. Data on community-associated ESBL-E infections/colonizations in Colombia are scarce. Georeferencing tools can be used to study the dynamics of antimicrobial resistance at the community level. Methods We conducted a study of geographic mapping using modern tools based on geographic information systems (GIS). Two study centers from the city of Pereira, Colombia were involved. The records of patients who had ESBL-producing Enterobacteriaceae were reviewed. Antimicrobial susceptibility testing and phenotypic detection of ESBL was done according to CLSI standards. Results A population of 415 patients with community-acquired infections/colonizations and 77 hospital discharges were obtained. Geographic distribution was established and heat maps were created. Several hotspots were evidenced in some geographical areas of the south-west and north-east of the city. Many of the affected areas were near tertiary hospitals, rivers, and poultry industry areas. Conclusions There are foci of antimicrobial resistance at the community level. This was demonstrated in the case of antimicrobial resistance caused by ESBL in a city in Colombia. Causality with tertiary hospitals in the city, some rivers and the poultry industry is proposed as an explanation of the evidenced phenomenon. Geographic mapping tools are useful for monitoring antimicrobial resistance in the community.
Collapse
|
20
|
Larson A, Hartinger SM, Riveros M, Salmon-Mulanovich G, Hattendorf J, Verastegui H, Huaylinos ML, Mäusezahl D. Antibiotic-Resistant Escherichia coli in Drinking Water Samples from Rural Andean Households in Cajamarca, Peru. Am J Trop Med Hyg 2020; 100:1363-1368. [PMID: 31017079 DOI: 10.4269/ajtmh.18-0776] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Antibiotic resistance in pathogenic bacteria is a serious public health issue. The growing threat is a cause for concern and action to prevent the emergence of new resistant strains and the spread of existing ones to humans via the environment. This study aimed at identifying fecal pathogens in drinking water obtained from rural Andean households from Cajamarca, Peru, and measuring the antibiotic resistance profile of Escherichia coli. The study was embedded within a community-randomized controlled trial among 102 communities in the northern highlands of the Cajamarca region, Peru. Of 314 samples, 55.4% (95% CI [49.7, 61.0], n = 174) were identified as thermotolerant coliforms. Among the samples positive for thermotolerant coliform, E. coli was isolated in 37.3% (n = 117), Klebsiella spp. in 8.0% (n = 25), Enterobacter spp. in 5.1% (n = 16), and Citrobacter spp. in 2.5% (n = 8). Of the 117 E. coli samples, 48.7% (95% CI [39.4, 58.1], n = 57) showed resistance to any antibiotic. The E. coli antibiotic resistance profile showed highest resistance against tetracycline (37.6%), ampicillin (34.2%), sulfamethoxazole-trimethoprim (21.4%), and nalidixic acid (13%). Some 19.7% (95% CI [12.9, 28.0], n = 23) of the E. coli isolates displayed multidrug resistance, defined as resistance to at least three classes of antibiotics. The CTX-M-3 gene, which encodes extended-spectrum resistance to beta-lactamase antibiotics, was found in one isolate. The high prevalence of fecal contamination in drinking water highlights the importance of household water treatment methods. Likewise, the high levels of antibiotic resistance found indicate a need for further research to identify the origins of potential environmental contamination, misuse, or inadequate disposal of antibiotics.
Collapse
Affiliation(s)
- Anika Larson
- University of Washington, Seattle, Washington.,Facultad de Salud Publica y Adminstración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Stella Maria Hartinger
- Facultad de Salud Publica y Adminstración, Universidad Peruana Cayetano Heredia, Lima, Peru.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Maribel Riveros
- Facultad de Salud Publica y Adminstración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Jan Hattendorf
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Hector Verastegui
- Facultad de Salud Publica y Adminstración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria Luisa Huaylinos
- Facultad de Salud Publica y Adminstración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Daniel Mäusezahl
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| |
Collapse
|
21
|
Nkansa-Gyamfi NA, Kazibwe J, Traore DAK, Nji E. Prevalence of multidrug-, extensive drug-, and pandrug-resistant commensal Escherichia coli isolated from healthy humans in community settings in low- and middle-income countries: a systematic review and meta-analysis. Glob Health Action 2019; 12:1815272. [PMID: 32909519 PMCID: PMC7782630 DOI: 10.1080/16549716.2020.1815272] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/23/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The majority of existing studies aimed at investigating the incidence and prevalence of multidrug-resistance by bacteria have been performed in healthcare settings. Relatively few studies have been conducted in community settings, but these have consistently shown a high prevalence of multidrug-resistant bacteria in low- and middle-income countries (LMICs). OBJECTIVES To provide an appraisal of the evidence on the high prevalence of multidrug-, extensive drug-, and pandrug-resistance in commensal Escherichia coli isolates from human sources in community settings in LMICs. METHODS Using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, PubMed, EMBASE, MEDLINE, Web of Science, CINAHL, and Cochrane Library databases were systematically searched with the search string: 'Enterobacteriaceae', OR 'E. coli', OR 'Escherichia coli', AND 'antibiotic resistance', OR 'antimicrobial resistance', OR 'drug-resistance', AND 'prevalence', OR 'incidence', OR 'morbidity', OR 'odds ratio', OR 'risk ratio', OR 'confidence interval', OR 'p-value', OR 'rate'. Data were extracted and proportional meta-analysis was performed using the Freeman-Tukey transformation random effect model. RESULTS The prevalence of multidrug-, extensive drug- and pandrug-resistance were extracted from articles that met our inclusion criteria and pooled together after a systematic screening of 9,369 items. The prevalence of multidrug-resistance was 28% of 14,336 total cases of isolates tested, 95% CI: 23-32. Extensive drug-resistance was 24% of 8,686 total cases of isolates tested, 95% CI: 14-36. Lastly, pandrug-resistance was 5% of 5,670 total cases of isolates tested, 95% CI: 3-8. CONCLUSION This paper provides an appraisal of the evidence on the high prevalence of multidrug-, extensive drug- and pandrug-resistance by commensal E. coli in community settings in LMICs. Our results call for greater effort to be placed at the community level in the design of new and improved public health policies to counter the global threat of antibiotic-resistant infections and bacteria.
Collapse
Affiliation(s)
| | - Joseph Kazibwe
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Daouda A. K. Traore
- BioStruct-Africa, Vårby, Sweden
- Faculte ′ Des Sciences Et Techniques, Universite ′ Des Sciences, Des Techniques Et Des Technologies De Bamako (USTTB), Bamako, Mali
- Life Sciences Group, Institut Laue- Langevin, Grenoble, France
- School of Life Sciences, Faculty of Natural Sciences, Keele University, Staffordshire, UK
| | | |
Collapse
|
22
|
Ditchburn JL, Hodgkins R. Yersinia pestis, a problem of the past and a re-emerging threat. BIOSAFETY AND HEALTH 2019. [DOI: 10.1016/j.bsheal.2019.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
|
23
|
Husan O, Çadirci Ö. Determination of extended spectrum β‐lactamase producing Enterobacteriaceae from cheese samples sold in public bazaars. J Food Saf 2019. [DOI: 10.1111/jfs.12680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Omar Husan
- Faculty of Veterinary Medicine, Department of Food Hygiene and TechnologyOndokuz Mayıs University Kurupelit/Samsun Turkey
| | - Özgür Çadirci
- Faculty of Veterinary Medicine, Department of Food Hygiene and TechnologyOndokuz Mayıs University Kurupelit/Samsun Turkey
| |
Collapse
|
24
|
Wang S, Mahfuz S, Song H. Effects of Flammulinavelutipes Stem Base on Microflora and Volatile Fatty Acids In Caecum of Growing Layers under Heat Stress Condition. BRAZILIAN JOURNAL OF POULTRY SCIENCE 2019. [DOI: 10.1590/1806-9061-2019-0989] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- S Wang
- Jilin Agricultural University, China
| | - S Mahfuz
- Jilin Agricultural University, China; Sylhet Agricultural University, Bangladesh
| | - H Song
- Jilin Agricultural University, China; Jilin Agricultural University, China
| |
Collapse
|
25
|
Caudell MA, Mair C, Subbiah M, Matthews L, Quinlan RJ, Quinlan MB, Zadoks R, Keyyu J, Call DR. Identification of risk factors associated with carriage of resistant Escherichia coli in three culturally diverse ethnic groups in Tanzania: a biological and socioeconomic analysis. Lancet Planet Health 2018; 2:e489-e497. [PMID: 30396440 PMCID: PMC6215761 DOI: 10.1016/s2542-5196(18)30225-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/10/2018] [Indexed: 05/07/2023]
Abstract
BACKGOUND Improved antimicrobial stewardship, sanitation, and hygiene are WHO-inspired priorities for restriction of the spread of antimicrobial resistance. Prioritisation among these objectives is essential, particularly in low-income and middle-income countries, but the factors contributing most to antimicrobial resistance are typically unknown and could vary substantially between and within countries. We aimed to identify the biological and socioeconomic risk factors associated with carriage of resistant Escherichia coli in three culturally diverse ethnic groups in northern Tanzania. METHODS We developed a survey containing more than 200 items and administered it in randomly selected households in 13 Chagga, Arusha, or Maasai villages chosen on the basis of ethnic composition and distance to urban centres. Human stool samples were collected from a subset of households, as were liquid milk samples and swabs of milk containers. Samples were processed and plated onto MacConkey agar plates, then presumptive E coli isolates were identified on the basis of colony morphology. Susceptibility of isolates was then tested against a panel of nine antimicrobials (ampicillin, ceftazidime, chloramphenicol, ciprofloxacin, kanamycin, streptomycin, sulfamethoxazole, tetracycline, and trimethoprim) via a breakpoint assay. Susceptibility findings were matched with data across a wide range of household characteristics, including education, hygiene practices, wealth, livestock husbandry, and antibiotic use. FINDINGS Between March 23, 2012, and July 30, 2015, we interviewed 391 households (118 Arusha, 100 Chagga, and 173 Maasai). Human stool samples were collected at 226 (58%) households across the 13 villages. 181 milk samples and 191 milk-container swabs were collected from 117 households across seven villages. 11 470 putative E coli samples were isolated from stool samples. Antimicrobial use in people and livestock was not associated with prevalence of resistance at the household level. Instead, the factors with the greatest predictive value involved exposure to bacteria, and were intimately connected with fundamental cultural differences across study groups. These factors included how different subsistence types (pastoralists vs farmers) access water sources and consumption of unboiled milk, reflecting increased exposure to resistant bacteria in milk. INTERPRETATION When cultural and ecological conditions favour bacterial transmission, there is a high likelihood that people will harbour antimicrobial-resistant bacteria irrespective of antimicrobial use practices. Public health interventions to limit antimicrobial resistance need to be tailored to local practices that affect bacterial transmission. FUNDING US National Science Foundation; Biotechnology and Biological Sciences Research Council, UK Medical Research Council; and the Allen School.
Collapse
Affiliation(s)
- Mark A Caudell
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, USA; Department of Anthropology, Washington State University, Pullman, WA, USA
| | - Colette Mair
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Murugan Subbiah
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
| | - Louise Matthews
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Robert J Quinlan
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, USA; Department of Anthropology, Washington State University, Pullman, WA, USA
| | - Marsha B Quinlan
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, USA; Department of Anthropology, Washington State University, Pullman, WA, USA
| | - Ruth Zadoks
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Julius Keyyu
- Tanzania Wildlife Research Institute, Arusha, Tanzania
| | - Douglas R Call
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, USA; Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania.
| |
Collapse
|
26
|
Carnero AM, Kitayama K, Diaz DA, Garvich M, Angulo N, Cama VA, Gilman RH, Bayer AM. Risk for interspecies transmission of zoonotic pathogens during poultry processing and pork production in Peru: A qualitative study. Zoonoses Public Health 2018; 65:528-539. [PMID: 29602269 DOI: 10.1111/zph.12463] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Indexed: 12/14/2022]
Abstract
Interspecies transmission of pathogens is an unfrequent but naturally occurring event and human activities may favour opportunities not previously reported. Reassortment of zoonotic pathogens like influenza A virus can result from these activities. Recently, swine and birds have played a central role as "mixing vessels" for epidemic and pandemic events related to strains like H1N1 and H5N1. Unsafe practices in poultry markets and swine farms can lead to interspecies transmission, favouring the emergence of novel strains. Thus, understanding practices that lead to interspecies interactions is crucial. This qualitative study aimed to evaluate poultry processing practices in formal and informal markets and the use of leftovers by swine farmers in three Peruvian cities: Lima (capital), Tumbes (coastal) and Tarapoto (jungle). We conducted 80 direct observations at formal and informal markets and interviewed 15 swine farmers. Processors slaughter and pluck chickens and vendors and/or processors eviscerate chickens. Food safety and hygiene practices were suboptimal or absent, although some heterogeneity was observed between cities and chicken vendors versus processors. Both vendors (76%) and processors (100%) sold the chicken viscera leftovers to swine farmers, representing the main source of chicken viscera for swine farms (53%). Swine farmers fed the chicken viscera to their swine. Chicken viscera cooking times varied widely and were insufficient in some cases. Non-abattoired poultry leads to the sale of poultry leftovers to small-scale swine farms, resulting in indirect but frequent interspecies contacts that can lead to interspecies transmission of bacterial pathogens or the reassortment of influenza A viruses. These interactions are exacerbated by suboptimal safety and hygiene conditions. People involved in these activities constitute an at-risk population who could play a central role in preventing the transmission of pathogens between species. Educational interventions on hygiene and food safety practices will be important for reducing the risk of interspecies influenza transmission.
Collapse
Affiliation(s)
- A M Carnero
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - K Kitayama
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - D A Diaz
- Asociación Benéfica Proyectos en Informática, Salud, Medicina y Agricultura (AB PRISMA), Lima, Peru
| | - M Garvich
- Asociación Benéfica Proyectos en Informática, Salud, Medicina y Agricultura (AB PRISMA), Lima, Peru
| | - N Angulo
- Asociación Benéfica Proyectos en Informática, Salud, Medicina y Agricultura (AB PRISMA), Lima, Peru
| | - V A Cama
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - R H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A M Bayer
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| |
Collapse
|
27
|
Saksena R, Gaind R, Sinha A, Kothari C, Chellani H, Deb M. High prevalence of fluoroquinolone resistance amongst commensal flora of antibiotic naïve neonates: a study from India. J Med Microbiol 2018; 67:481-488. [PMID: 29458558 DOI: 10.1099/jmm.0.000686] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The emergence of resistance amongst commensal flora is a serious threat to the community. However, there is paucity of data regarding antibiotic resistance in commensals in the absence of antibiotic pressure. METHODS Altogether, 100 vaginally delivered antibiotic naïve exclusively breastfed neonates were selected. Stool samples collected on day (D)1, D21 and D60 of birth were cultured. Enterobacteriaceae isolates were screened for nalidixic acid (NA) and ciprofloxacin susceptibility as per CLSI guidelines. In 28 randomly selected neonates, isolates (n=92) resistant to NA and ciprofloxacin were characterized for the presence of plasmid-mediated quinolone resistance (PMQR) genes (qnrA, qnrB and qnrS, qepAand aac(6')-Ib-cr) and mutations in the quinolone resistance determining region (QRDR) of gyrA and parC genes by specific primers and confirmed by sequencing. RESULTS A total of 343 Enterobacteriaceae were isolated from 100 neonates. On D1, 58 % of neonates were colonized with at least one Enterobacteriaceae predominantly E. coli. Overall resistance to NA was 60 % but ciprofloxacin resistance increased significantly from 15 % (14/96) on D1 to 38 % (50/132) on D60 (P-value <0.001). The predominant mechanism of fluoroquinolone resistance was mutation in gyrA (n=49) with or without PMQR. PMQR carrying isolates increased more than fivefold from D1 to D60. CONCLUSION A high level of fluoroquinolone resistance in gut flora of antibiotic naïve and exclusively breastfed neonates suggests a rampant rise of resistance in the community. The source of resistance genes on D1 is probably maternal flora acquired at birth. High load of PMQR genes in commensal flora are a potential source of spread to pathogenic organisms.
Collapse
Affiliation(s)
- Rushika Saksena
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rajni Gaind
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Anju Sinha
- Department of Reproductive and Child Health, Indian council of Medical Research, New Delhi, India
| | - Charu Kothari
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Harish Chellani
- Department of Paediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Manorama Deb
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| |
Collapse
|
28
|
Correlates of multi-drug non-susceptibility in enteric bacteria isolated from Kenyan children with acute diarrhea. PLoS Negl Trop Dis 2017; 11:e0005974. [PMID: 28968393 PMCID: PMC5638605 DOI: 10.1371/journal.pntd.0005974] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 10/12/2017] [Accepted: 09/19/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Reduced antimicrobial susceptibility threatens treatment efficacy in sub-Saharan Africa, where data on the burden and correlates of antibiotic resistance among enteric pathogens are limited. METHODS Fecal samples from children aged 6 mos-15 yrs presenting with acute diarrhea in western Kenya were cultured for bacterial pathogens. HIV-uninfected children with identified Shigella or Salmonella species or pathogenic Escherichia coli (EPEC, ETEC, EAEC or EIEC) were included in this cross-sectional sub-study. Non-susceptibility to ampicillin, ceftriaxone, ciprofloxacin, cotrimoxazole, and tetracycline was determined using MicroScan Walkaway40 Plus. Multivariable log-binomial regression was used to identify correlates of multi-drug non-susceptibility (MDNS, non-susceptibility to ≥ 3 of these antibiotics). RESULTS Of 292 included children, median age was 22.5 mos. MDNS was identified in 62.5% of 318 isolates. Non-susceptibility to cotrimoxazole (92.8%), ampicillin (81.3%), and tetracycline (75.0%) was common. Young age (6-24 mos vs. 24-59 mos adjusted prevalence ratio [aPR] = 1.519 [95% confidence interval: 1.19, 1.91]), maternal HIV (aPR = 1.29 [1.01, 1.66]); and acute malnutrition (aPR = 1.28 [1.06, 1.55]) were associated with higher prevalence of MDNS, as were open defecation (aPR = 2.25 [1.13, 4.50]), household crowding (aPR = 1.29 [1.08, 1.53]) and infrequent caregiver hand-washing (aPR = 1.50 [1.15, 1.95]). CONCLUSIONS Young age, HIV exposure, acute malnutrition and poor sanitation may increase risk of antibiotic non-susceptible enteric pathogen infections among children in Kenya.
Collapse
|
29
|
Katakweba AAS, Muhairwa AP, Lupindu AM, Damborg P, Rosenkrantz JT, Minga UM, Mtambo MMA, Olsen JE. First Report on a Randomized Investigation of Antimicrobial Resistance in Fecal Indicator Bacteria from Livestock, Poultry, and Humans in Tanzania. Microb Drug Resist 2017; 24:260-268. [PMID: 28759321 DOI: 10.1089/mdr.2016.0297] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study provides an estimate of antimicrobial resistance in intestinal indicator bacteria from humans (n = 97) and food animals (n = 388) in Tanzania. More than 70% of all fecal samples contained tetracycline (TE), sulfamethoxazole (STX), and ampicillin (AMP)-resistant coliforms, while cefotaxime (CTX)-resistant coliforms were observed in 40% of all samples. The average Log10 colony forming units/g of CTX-resistant coliforms in samples from humans were 2.20. Of 390 Escherichia coli tested, 66.4% were resistant to TE, 54.9% to STX, 54.9% to streptomycin, and 36.4% to CTX. Isolates were commonly (65.1%) multiresistant. All CTX-resistant isolates contained blaCTX-M gene type. AMP- and vancomycin-resistant enterococci were rare, and the average concentrations in positive samples were low (log10 0.9 and 0.4, respectively). A low-to-moderate resistance (2.1-15%) was detected in 240 enterococci isolates to the drugs tested, except for rifampicin resistance (75.2% of isolates). The average number of sulII gene copies varied between Log10 5.37 and 5.68 with no significant difference between sample source, while cattle had significantly higher number of tetW genes than humans. These findings, based on randomly obtained samples, will be instrumental in designing antimicrobial resistance (AMR) intervention strategies for Tanzania.
Collapse
Affiliation(s)
- Abdul A S Katakweba
- 1 Department of Public Health, Pest Management Centre, Sokoine University of Agriculture , Morogoro, Tanzania
| | - Amandus P Muhairwa
- 2 Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture , Morogoro, Tanzania
| | - Athumani M Lupindu
- 2 Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture , Morogoro, Tanzania
| | - Peter Damborg
- 3 Department of Veterinary and Animal Sciences, University of Copenhagen , Frederiksberg C, Denmark
| | - Jesper T Rosenkrantz
- 3 Department of Veterinary and Animal Sciences, University of Copenhagen , Frederiksberg C, Denmark
| | - Uswege M Minga
- 4 Provost's Office, Tumaini University Dar es Salaam College (TUDARCo) , Dar es Salaam, Tanzania
| | - Madundo M A Mtambo
- 2 Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture , Morogoro, Tanzania
| | - John E Olsen
- 3 Department of Veterinary and Animal Sciences, University of Copenhagen , Frederiksberg C, Denmark
| |
Collapse
|
30
|
Bryce A, Costelloe C, Hawcroft C, Wootton M, Hay AD. Faecal carriage of antibiotic resistant Escherichia coli in asymptomatic children and associations with primary care antibiotic prescribing: a systematic review and meta-analysis. BMC Infect Dis 2016; 16:359. [PMID: 27456093 PMCID: PMC4960702 DOI: 10.1186/s12879-016-1697-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 07/08/2016] [Indexed: 01/21/2023] Open
Abstract
Background The faecal reservoir provides optimal conditions for the transmission of resistance genes within and between bacterial species. As key transmitters of infection within communities, children are likely important contributors to endemic community resistance. We sought to determine the prevalence of antibiotic-resistant faecal Escherichia coli from asymptomatic children aged between 0 and 17 years worldwide, and investigate the impact of routinely prescribed primary care antibiotics to that resistance. Methods A systematic search of Medline, Embase, Cochrane and Web of Knowledge databases from 1940 to 2015. Pooled resistance prevalence for common primary care antibiotics, stratified by study country OECD status. Random-effects meta-analysis to explore the association between antibiotic exposure and resistance. Results Thirty-four studies were included. In OECD countries, the pooled resistance prevalence to tetracycline was 37.7 % (95 % CI: 25.9–49.7 %); ampicillin 37.6 % (24.9–54.3 %); and trimethoprim 28.6 % (2.2–71.0 %). Resistance in non-OECD countries was uniformly higher: tetracycline 80.0 % (59.7–95.3 %); ampicillin 67.2 % (45.8–84.9 %); and trimethoprim 81.3 % (40.4–100 %). We found evidence of an association between primary care prescribed antibiotics and resistance lasting for up to 3 months post-prescribing (pooled OR: 1.65, 1.36–2.0). Conclusions Resistance to many primary care prescribed antibiotics is common among faecal E. coli carried by asymptomatic children, with higher resistance rates in non-OECD countries. Despite tetracycline being contra-indicated in children, tetracycline resistance rates were high suggesting children could be important recipients and transmitters of resistant bacteria, or that use of other antibiotics is leading to tetracycline resistance via inter-bacteria resistance transmission. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1697-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ashley Bryce
- Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Céire Costelloe
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, W12 0NN, London, UK
| | - Claire Hawcroft
- Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Mandy Wootton
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| |
Collapse
|
31
|
Leite-Martins L, Mahú MI, Costa AL, Bessa LJ, Vaz-Pires P, Loureiro L, Niza-Ribeiro J, de Matos AJF, Martins da Costa P. Prevalence of antimicrobial resistance in faecal enterococci from vet-visiting pets and assessment of risk factors. Vet Rec 2015; 176:674. [PMID: 26078332 DOI: 10.1136/vr.102888] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2015] [Indexed: 12/15/2022]
Abstract
The objective of this study was to determine the prevalence of antimicrobial resistance (AMR) exhibited by enterococci isolated from faeces of pets and its underlying risk factors. From September 2009 to May 2012, rectal swabs were collected from 74 dogs and 17 cats, selected from the population of animals visiting the Veterinary Hospital of University of Porto, UPVet, through a systematic random procedure. Animal owners answered a questionnaire about the risk factors that could influence the presence of AMR in faecal enterococci. Enterococci isolation, identification and antimicrobial (AM) susceptibility testing were performed. Data analyses of multilevel, univariable and multivariable generalised linear mixed models were conducted. From all enterococci isolated (n=315), 61 per cent were considered multidrug-resistant, whereas only 9.2 per cent were susceptible to all AMs tested. Highest resistance was found to tetracycline (67.0 per cent), rifampicin (60.3 per cent), azithromycin (58.4 per cent), quinupristin/dalfopristin (54.0 per cent) and erythromycin (53.0 per cent). Previous fluoroquinolone treatments and coprophagic habits were the features more consistently associated with the presence of AMR for three (chloramphenicol, ciprofloxacin and azithromycin) and seven (tetracycline, rifampicin, gentamicin, chloramphenicol, ciprofloxacin, erythromycin and azithromycin), respectively, out of nine AMs assessed. Evaluating risk factors that determine the presence of drug-resistant bacteria in pets, a possible source of resistance determinants to human beings, is crucial for the selection of appropriate treatment guidelines by veterinary practitioners.
Collapse
Affiliation(s)
- L Leite-Martins
- Department of Veterinary Clinics - UPVet, Abel Salazar Institute for the Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal Department of Aquatic Production, ICBAS, University of Porto, Porto, Portugal
| | - M I Mahú
- Department of Aquatic Production, ICBAS, University of Porto, Porto, Portugal Gulbenkian Science Institute, Lisbon, Portugal
| | - A L Costa
- Department of Aquatic Production, ICBAS, University of Porto, Porto, Portugal
| | - L J Bessa
- Department of Aquatic Production, ICBAS, University of Porto, Porto, Portugal Interdisciplinary Centre for Marine and Environmental Research (CIIMAR), University of Porto, Porto, Portugal
| | - P Vaz-Pires
- Department of Aquatic Production, ICBAS, University of Porto, Porto, Portugal
| | - L Loureiro
- Department of Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, USA
| | - J Niza-Ribeiro
- Department of Population Studies, ICBAS, and Institute of Public Health (ISPUP), University of Porto, Porto, Portugal
| | - A J F de Matos
- Department of Veterinary Clinics - UPVet, Abel Salazar Institute for the Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal Animal Science and Study Centre/Food and Agrarian Sciences and Technologies Institute (CECA/ICETA), University of Porto, Porto, Portugal
| | - P Martins da Costa
- Department of Aquatic Production, ICBAS, University of Porto, Porto, Portugal Interdisciplinary Centre for Marine and Environmental Research (CIIMAR), University of Porto, Porto, Portugal
| |
Collapse
|
32
|
Quality of water and antibiotic resistance of Escherichia coli from water sources of hilly tribal villages with and without integrated watershed management-a one year prospective study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 11:6156-70. [PMID: 24991664 PMCID: PMC4078572 DOI: 10.3390/ijerph110606156] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In many hilly tribal areas of the world, water scarcity is a major problem and diarrhoea is common. Poor quality of water also affects the environment. An integrated watershed management programme (IWMP) aims to increase availability of water and to improve life conditions. Globally, there is a lack of information on water contamination, occurrence of diarrhoea and antibiotic resistance, a serious global concern, in relation to IWMP in hilly tribal areas. Therefore, a prospective observational study was conducted during 2011–2012 in six villages in a hilly tribal belt of India, three with and three without implementation of an IWMP, to explore quality of water, diarrhoeal cases in the community and antibiotic resistance of Escherichia coli from water sources. The results showed that physico-chemical quality of water was within limits of safe consumption in all samples. The odds of coliform contamination in water samples was 2.3 times higher in non-watershed management villages (NWMV) compared to integrated watershed management villages (IWMV) (95% CI 0.8–6.45, p = 0.081). The number of diarrhoeal cases (18/663 vs. 42/639, p < 0.05) was lower in IWMV as compared to NWMV. Overall E. coli isolates showed high susceptibility to antibiotics. Resistance to a wider range of antibiotics was observed in NWMV.
Collapse
|
33
|
Leite-Martins LR, Mahú MIM, Costa AL, Mendes A, Lopes E, Mendonça DMV, Niza-Ribeiro JJR, de Matos AJF, da Costa PM. Prevalence of antimicrobial resistance in enteric Escherichia coli from domestic pets and assessment of associated risk markers using a generalized linear mixed model. Prev Vet Med 2014; 117:28-39. [PMID: 25294317 DOI: 10.1016/j.prevetmed.2014.09.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 09/19/2014] [Accepted: 09/19/2014] [Indexed: 11/18/2022]
Abstract
Antimicrobial resistance (AMR) is a growing global public health problem, which is caused by the use of antimicrobials in both human and animal medical practice. The objectives of the present cross-sectional study were as follows: (1) to determine the prevalence of resistance in Escherichia coli isolated from the feces of pets from the Porto region of Portugal against 19 antimicrobial agents and (2) to assess the individual, clinical and environmental characteristics associated with each pet as risk markers for the AMR of the E. coli isolates. From September 2009 to May 2012, rectal swabs were collected from pets selected using a systematic random procedure from the ordinary population of animals attending the Veterinary Hospital of Porto University. A total of 78 dogs and 22 cats were sampled with the objective of isolating E. coli. The animals' owners, who allowed the collection of fecal samples from their pets, answered a questionnaire to collect information about the markers that could influence the AMR of the enteric E. coli. Chromocult tryptone bile X-glucuronide agar was used for E. coli isolation, and the disk diffusion method was used to determine the antimicrobial susceptibility. The data were analyzed using a multilevel, univariable and multivariable generalized linear mixed model (GLMM). Several (49.7%) of the 396 isolates obtained in this study were multidrug-resistant. The E. coli isolates exhibited resistance to the antimicrobial agent's ampicillin (51.3%), cephalothin (46.7%), tetracycline (45.2%) and streptomycin (43.4%). Previous quinolone treatment was the main risk marker for the presence of AMR for 12 (ampicillin, cephalothin, ceftazidime, cefotaxime, nalidixic acid, ciprofloxacin, gentamicin, tetracycline, streptomycin, chloramphenicol, trimethoprim-sulfamethoxazole and aztreonam) of the 15 antimicrobials assessed. Coprophagic habits were also positively associated with an increased risk of AMR for six drugs, ampicillin, amoxicillin-clavulanic acid, cephamycin, ciprofloxacin, streptomycin, and trimethoprim-sulfamethoxazole. In summary, pets with a record of one or more previous quinolone treatments and exhibiting coprophagic habits were at an increased risk of harboring multidrug-resistant E. coli strains in their feces compared to pets without these characteristics. AMR is a serious global problem, and assessing the risk markers for the presence of drug-resistant bacteria in pets, a very close source of resistance determinants to humans, is essential for the implementation of safe handling procedures for companion animals and for the prudent selection of antimicrobial compounds in veterinary practice.
Collapse
Affiliation(s)
- Liliana R Leite-Martins
- Veterinary Clinics Department, Abel Salazar Institute for the Biomedical Sciences (ICBAS), Porto University (UP), Portugal.
| | - Maria I M Mahú
- Microbiology and Food Technology Department, Abel Salazar Institute for the Biomedical Sciences (ICBAS), Porto University (UP), Portugal
| | - Ana L Costa
- Microbiology and Food Technology Department, Abel Salazar Institute for the Biomedical Sciences (ICBAS), Porto University (UP), Portugal
| | - Angelo Mendes
- Microbiology and Food Technology Department, Abel Salazar Institute for the Biomedical Sciences (ICBAS), Porto University (UP), Portugal
| | - Elisabete Lopes
- Microbiology and Food Technology Department, Abel Salazar Institute for the Biomedical Sciences (ICBAS), Porto University (UP), Portugal
| | - Denisa M V Mendonça
- Population Studies Department, Abel Salazar Institute for the Biomedical Sciences (ICBAS), Porto University (UP), Portugal; Public Health Institute (ISPUP), Porto University (UP), Portugal
| | - João J R Niza-Ribeiro
- Population Studies Department, Abel Salazar Institute for the Biomedical Sciences (ICBAS), Porto University (UP), Portugal; Public Health Institute (ISPUP), Porto University (UP), Portugal
| | - Augusto J F de Matos
- Veterinary Clinics Department, Abel Salazar Institute for the Biomedical Sciences (ICBAS), Porto University (UP), Portugal
| | - Paulo Martins da Costa
- Microbiology and Food Technology Department, Abel Salazar Institute for the Biomedical Sciences (ICBAS), Porto University (UP), Portugal
| |
Collapse
|
34
|
Seidman JC, Coles CL, Silbergeld EK, Levens J, Mkocha H, Johnson LB, Muñoz B, West SK. Increased carriage of macrolide-resistant fecal E. coli following mass distribution of azithromycin for trachoma control. Int J Epidemiol 2014; 43:1105-13. [PMID: 24659584 DOI: 10.1093/ije/dyu062] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mass drug treatment with azithromycin (MDA) is part of the WHO-endorsed 'SAFE' strategy for trachoma control in endemic communities. MDA has been associated with reduced trachoma prevalence and short-term reductions in other bacterial infections, but can also lead to increased circulation of macrolide-resistant bacteria. METHODS We prospectively monitored macrolide resistance in fecal E. coli collected from young children participating in the PRET+ Study in rural Tanzania. MDA was administered in four villages with >10% trachoma prevalence. Four nearby communities with lower trachoma prevalence served as controls. Rectal swabs were collected during cross-sectional surveys performed at baseline, 1, 3 and 6 months after MDA. Fecal E. coli isolates were screened for macrolide susceptibility using disc diffusion and minimum inhibitory concentration methods. Cross-sectional and longitudinal differences in resistance prevalence by MDA exposure were compared using t-tests and logistic regression. RESULTS There was no difference in the proportion of individuals carrying azithromycin-resistant E. coli at baseline (0.21 vs. 0.16, P > 0.05). Azithromycin resistance carriage prevalence remained stable over follow-up in non-MDA villages but increased sharply in MDA villages (0.61 at 1 month, 0.42 at 3 months and 0.31 at 6 months). MDA exposure was highly associated with azithromycin resistance carriage at 1 month post-MDA (OR 15.27, P < 0.001) and subsequent surveys. Younger age and recent diarrhoea were also associated with increased odds of resistance (P < 0.01). CONCLUSIONS MDA resulted in significantly increased prevalence of macrolide resistance in E. coli. Although MDA is effective for trachoma elimination, it has costs; it is essential to monitor antimicrobial resistance following MDA.
Collapse
Affiliation(s)
- Jessica C Seidman
- Department of International Health, Department of Environmental Health and Dana Center for Preventive Ophthalmology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Kongwa Trachoma Project, Kongwa, United Republic of Tanzania and Biology Department, Morgan State University, Baltimore, MD, USA
| | - Christian L Coles
- Department of International Health, Department of Environmental Health and Dana Center for Preventive Ophthalmology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Kongwa Trachoma Project, Kongwa, United Republic of Tanzania and Biology Department, Morgan State University, Baltimore, MD, USA
| | - Ellen K Silbergeld
- Department of International Health, Department of Environmental Health and Dana Center for Preventive Ophthalmology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Kongwa Trachoma Project, Kongwa, United Republic of Tanzania and Biology Department, Morgan State University, Baltimore, MD, USA
| | - Joshua Levens
- Department of International Health, Department of Environmental Health and Dana Center for Preventive Ophthalmology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Kongwa Trachoma Project, Kongwa, United Republic of Tanzania and Biology Department, Morgan State University, Baltimore, MD, USA
| | - Harran Mkocha
- Department of International Health, Department of Environmental Health and Dana Center for Preventive Ophthalmology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Kongwa Trachoma Project, Kongwa, United Republic of Tanzania and Biology Department, Morgan State University, Baltimore, MD, USA
| | - Lashaunda B Johnson
- Department of International Health, Department of Environmental Health and Dana Center for Preventive Ophthalmology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Kongwa Trachoma Project, Kongwa, United Republic of Tanzania and Biology Department, Morgan State University, Baltimore, MD, USA
| | - Beatriz Muñoz
- Department of International Health, Department of Environmental Health and Dana Center for Preventive Ophthalmology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Kongwa Trachoma Project, Kongwa, United Republic of Tanzania and Biology Department, Morgan State University, Baltimore, MD, USA
| | - Sheila K West
- Department of International Health, Department of Environmental Health and Dana Center for Preventive Ophthalmology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Kongwa Trachoma Project, Kongwa, United Republic of Tanzania and Biology Department, Morgan State University, Baltimore, MD, USA
| |
Collapse
|
35
|
Osman KM, Hassan WMM, Mohamed RAH. The consequences of a sudden demographic change on the seroprevalence pattern, virulence genes, identification and characterisation of integron-mediated antibiotic resistance in the Salmonella enterica isolated from clinically diarrhoeic humans in Egypt. Eur J Clin Microbiol Infect Dis 2014; 33:1323-37. [DOI: 10.1007/s10096-014-2072-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/27/2014] [Indexed: 12/20/2022]
|
36
|
Aduda DSO, Macharia IM, Mugwe P, Oburra H, Farragher B, Brabin B, Mackenzie I. Bacteriology of chronic suppurative otitis media (CSOM) in children in Garissa district, Kenya: a point prevalence study. Int J Pediatr Otorhinolaryngol 2013; 77:1107-11. [PMID: 23711391 DOI: 10.1016/j.ijporl.2013.04.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 04/12/2013] [Accepted: 04/15/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To identify by type and sensitivity to drugs the bacteria found in ears of school-going children with chronic otitis media in Garissa district. STUDY DESIGN This was a descriptive prevalence study of CSOM bacterial flora in eligible ears conducted among a cohort of children attending public and private primary as well as Islamic religious schools, screened for chronic ear discharge in Garissa district, Kenya. Procedure and bacteriological techniques: We used sterile swab-sticks to collect a specimen of the discharge from eligible ears of consenting pupils at the induction stage of the zinc supplementation trial for treatment of chronic suppurative otitis media conducted between January and July 2010. All pupils below 18 years present on day of visit were eligible. Both aerobic and anaerobic bacterial cultures were done to identify clinically and epidemiologically important bacteria. Sensitivity tests were based on disc diffusion methods. Results are presented as frequencies and proportions. RESULTS Of the pupils seen, 61% were still in pre- or lower primary school. Majority were aged 13 and 14 years. Of the 261 ear swab samples processed, 336 isolates - either in mixed or pure flora - were identified, being almost exclusively aerobes. Proteus spp., Enterococcus, Staphylococcus aureus and Pseudomonas spp. were isolated in 32.7%, 28.6%, 12.8% and 11.3% respectively. Proteus was susceptible to majority of the antibiotics tested for, while Enterococcus was poorly susceptible. CONCLUSIONS Aerobic bacteria were most prevalent in this study. Several of the bacteria identified are known to require iron for their growth. This may be important for CSOM treatment if biofilm formation is involved in pathogenesis. Majority of the isolates were susceptible to basic antibiotics compared to Enterococcus bacteria. This portends an important consideration for clinical management and therapeutic decision-making. Additionally, given the prevalence of Enterococcus bacteria, which is an indicator of faecal contamination of the environment, there is need to consider relevant public health components in managing childhood CSOM besides the clinical ones alone.
Collapse
Affiliation(s)
- Dickens S O Aduda
- University of Nairobi, School of Health Sciences, Department of Surgery, ENT/Head & Neck Surgery, Kenya.
| | | | | | | | | | | | | |
Collapse
|
37
|
Galvin S, Bergin N, Hennessy R, Hanahoe B, Murphy AW, Cormican M, Vellinga A. Exploratory Spatial Mapping of the Occurrence of Antimicrobial Resistance in E. coli in the Community. Antibiotics (Basel) 2013; 2:328-38. [PMID: 27029306 PMCID: PMC4790267 DOI: 10.3390/antibiotics2030328] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 06/11/2013] [Accepted: 06/21/2013] [Indexed: 12/03/2022] Open
Abstract
The use of antimicrobials over the past six decades has been associated with the emergence and dissemination of antimicrobial-resistant bacteria. To explore local geographical patterns in the occurrence of acquired antimicrobial resistance (AMR), AMR of E. coli causing urinary tract infections (UTI) in the community in the West of Ireland was mapped. All adult patients consulting with a suspected UTI in 22 general practices in the West of Ireland over a nine-month study period were requested to supply a urine sample. Those with a laboratory confirmed E. coli infection were included (n = 752) in the study. Antimicrobial susceptibility testing was performed by standardized disc diffusion. Patient addresses were geocoded. The diameters of the zone of inhibition of growth for trimethoprim (5 μg) and ciprofloxacin (5 μg) for the relevant isolate was mapped against the patient address using ArcGIS software. A series of maps illustrating spatial distribution of AMR in the West of Ireland were generated. The spatial data demonstrated a higher proportion of isolates with AMR from urban areas. Some rural areas also showed high levels of resistant E. coli. Our study is the first to demonstrate the feasibility of using a geographical information system (GIS) platform for routine visual geographical analysis of AMR data in Ireland. Routine presentation of AMR data in this format may be valuable in understanding AMR trends at a local level.
Collapse
Affiliation(s)
- Sandra Galvin
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.
| | - Niall Bergin
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.
| | - Ronan Hennessy
- GIS Centre, Ryan Institute, National University of Ireland, Galway, Ireland.
| | - Belinda Hanahoe
- Department of Medical Microbiology, University Hospital Galway, Galway, Ireland.
| | - Andrew W Murphy
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.
| | - Martin Cormican
- Department of Medical Microbiology, University Hospital Galway, Galway, Ireland.
- Discipline of Bacteriology, School of Medicine, National University of Ireland, Galway, Ireland.
| | - Akke Vellinga
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.
- Discipline of Bacteriology, School of Medicine, National University of Ireland, Galway, Ireland.
| |
Collapse
|
38
|
Bhattacharya S. Early diagnosis of resistant pathogens: how can it improve antimicrobial treatment? Virulence 2013; 4:172-84. [PMID: 23302786 PMCID: PMC3654618 DOI: 10.4161/viru.23326] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Infections with organisms that are resistant to various anti-microbial agents pose a serious challenge to effective management of infections. Resistance to antimicrobial agents, which may be intrinsic or acquired, has been noted in a wide variety of microorganisms causing human infections. These include resistance to antiviral agents in HIV, HBV, CMV and influenza virus, anti-parasitic agents in Plasmodium falciparum, anti-fungal agents in certain Candida species and MDR (multidrug-resistant) tuberculosis. It is however, the problem of multidrug-resistant bacterial infections (caused by MRSA, VRE, ESBL/AmpC/metallo-β lactamase producers and colistin-resistant Gram-negative bacilli) that has become a cause of major concern in clinical settings. Infections with these organisms can increase morbidity, mortality, increase the cost of therapy and increase the duration of hospitalization. The objective of this article is to review the question how early diagnosis of these infections, affects the overall management of infected or colonized patients, with regard to antimicrobial therapy.
Collapse
|
39
|
Dalhoff A. Global fluoroquinolone resistance epidemiology and implictions for clinical use. Interdiscip Perspect Infect Dis 2012; 2012:976273. [PMID: 23097666 PMCID: PMC3477668 DOI: 10.1155/2012/976273] [Citation(s) in RCA: 212] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 06/26/2012] [Indexed: 12/22/2022] Open
Abstract
This paper on the fluoroquinolone resistance epidemiology stratifies the data according to the different prescription patterns by either primary or tertiary caregivers and by indication. Global surveillance studies demonstrate that fluoroquinolone resistance rates increased in the past years in almost all bacterial species except S. pneumoniae and H. influenzae, causing community-acquired respiratory tract infections. However, 10 to 30% of these isolates harbored first-step mutations conferring low level fluoroquinolone resistance. Fluoroquinolone resistance increased in Enterobacteriaceae causing community acquired or healthcare associated urinary tract infections and intraabdominal infections, exceeding 50% in some parts of the world, particularly in Asia. One to two-thirds of Enterobacteriaceae producing extended spectrum β-lactamases were fluoroquinolone resistant too. Furthermore, fluoroquinolones select for methicillin resistance in Staphylococci. Neisseria gonorrhoeae acquired fluoroquinolone resistance rapidly; actual resistance rates are highly variable and can be as high as almost 100%, particularly in Asia, whereas resistance rates in Europe and North America range from <10% in rural areas to >30% in established sexual networks. In general, the continued increase in fluoroquinolone resistance affects patient management and necessitates changes in some guidelines, for example, treatment of urinary tract, intra-abdominal, skin and skin structure infections, and traveller's diarrhea, or even precludes the use in indications like sexually transmitted diseases and enteric fever.
Collapse
Affiliation(s)
- Axel Dalhoff
- Institute for Infection-Medicine, Christian-Albrechts Univerity of Kiel and University Medical Center Schleswig-Holstein, Brunswiker Straße 4, 24105 Kiel, Germany
| |
Collapse
|
40
|
Pollett S, Rocha C, Zerpa R, Patiño L, Valencia A, Camiña M, Guevara J, Lopez M, Chuquiray N, Salazar-Lindo E, Calampa C, Casapia M, Meza R, Bernal M, Tilley D, Gregory M, Maves R, Hall E, Jones F, Arriola CS, Rosenbaum M, Perez J, Kasper M. Campylobacter antimicrobial resistance in Peru: a ten-year observational study. BMC Infect Dis 2012; 12:193. [PMID: 22898609 PMCID: PMC3482591 DOI: 10.1186/1471-2334-12-193] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 06/19/2012] [Indexed: 11/16/2022] Open
Abstract
Background Campylobacter jejuni and Campylobacter coli are food-borne pathogens of great importance and feature prominently in the etiology of developing world enteritis and travellers’ diarrhoea. Increasing antimicrobial resistant Campylobacter prevalence has been described globally, yet data from Peru is limited. Our objective was to describe the prevalence trends of fluoroquinolone and macrolide-resistant C. jejuni and C. coli stool isolates from three regions in Peru over a ten-year period. Methods Surveillance for enteric pathogens was conducted in Lima, Iquitos and Cusco between 2001 and 2010. Campylobacter stool isolates were tested for susceptibilities to ciprofloxacin, azithromycin and erythromycin. Susceptibilities were reviewed for 4652 isolates from Lima ( n = 3419), Iquitos ( n = 625) and Cusco ( n = 608). Results Comparing the study periods of 2001-2005 and 2006-2010, prevalence of ciprofloxacin-resistant C. jejuni isolates rose in the study areas of Lima (73.1% to 89.8%, p < 0.001) and Iquitos (24.1% to 48.9%, p < 0.001). Ciprofloxacin-resistant C. coli rates also increased in Lima (48.1% to 87.4%, p < 0.001) and Cusco (10.0% to 65.9%, p = 0.005). Small but significant increases in azithromycin-resistant and erythromycin-resistant C. jejuni prevalence were noted in Iquitos (2.2% to 14.9%, p < 0.001; 3.2% to 14.9%, p = 0.002), and erythromycin-resistant C. coli rates increased in Lima (0.0% to 5.3%, p = 0.038). The prevalence of C. jejuni isolates resistant to both ciprofloxacin and azithromycin increased in Iquitos (0.3% to 14.9%, p < 0.001) and Lima (0.3% to 1.6%, p = 0.011), and prevalence of C. jejuni isolates resistant to both ciprofloxacin and erythromycin rose in Iquitos (0.0% to 14.9%, p < 0.001). Ciprofloxacin and erythromycin resistant C. coli prevalence increased in Lima (0.0% to 5.3%, p = 0.034). Conclusions These results have implications for the empirical management of enterocolitis in Peru. Ongoing surveillance is essential to guide appropriate antimicrobial use in this setting. Local epidemiological studies to explore the relationship between increasing antimicrobial resistance and agricultural or human antibiotic use may be valuable.
Collapse
Affiliation(s)
- Simon Pollett
- Bacteriology Department, U.S. Naval Medical Research Unit-6 (NAMRU-6), Venezuela Ave, Block 36, Callao 2, Lima, Peru.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Dyar OJ, Hoa NQ, Trung NV, Phuc HD, Larsson M, Chuc NTK, Lundborg CS. High prevalence of antibiotic resistance in commensal Escherichia coli among children in rural Vietnam. BMC Infect Dis 2012; 12:92. [PMID: 22512857 PMCID: PMC3353216 DOI: 10.1186/1471-2334-12-92] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Accepted: 04/18/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Commensal bacteria represent an important reservoir of antibiotic resistance genes. Few community-based studies of antibiotic resistance in commensal bacteria have been conducted in Southeast Asia. We investigated the prevalence of resistance in commensal Escherichia coli in preschool children in rural Vietnam, and factors associated with carriage of resistant bacteria. METHODS We tested isolates of E. coli from faecal samples of 818 children aged 6-60 months living in FilaBavi, a demographic surveillance site near Hanoi. Daily antibiotic use data was collected for participating children for three weeks prior to sampling and analysed with socioeconomic and demographic characteristics extracted from FilaBavi's re-census survey 2007. Descriptive statistics were generated, and a logistic regression model was used to identify contributions of the examined factors. RESULTS High prevalences of resistance were found to tetracycline (74%), co-trimoxazole (68%), ampicillin (65%), chloramphenicol (40%), and nalidixic acid (27%). Two isolates were resistant to ciprofloxacin. Sixty percent of isolates were resistant to three or more antibiotics. Recent sulphonamide use was associated with co-trimoxazole resistance [OR 3.2, 95% CI 1.8-5.7], and beta-lactam use with ampicillin resistance [OR 1.8, 95% CI 1.3-2.4]. Isolates from children aged 6-23 months were more likely to be resistant to ampicillin [OR 1.8, 95% CI 1.3-2.4] and co-trimoxazole [OR 1.5, 95% CI 1.1-2.0]. Associations were identified between geographical areas and tetracycline and ampicillin resistance. CONCLUSIONS We present high prevalence of carriage of commensal E. coli resistant to commonly used antibiotics. The identified associations with recent antibiotic use, age, and geographical location might contribute to our understanding of carriage of antibiotic resistant commensal bacteria.
Collapse
Affiliation(s)
- Oliver James Dyar
- Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Nobels väg 9, 171 77 Stockholm, Sweden
| | - Nguyen Quynh Hoa
- Health System Research, Hanoi Medical University, 1 Ton That Tung street, Hanoi, Vietnam
- Vietnam Cuba Friendship Hospital, 37 Hai Ba Trung street, Hanoi, Vietnam
| | - Nguyen V Trung
- Department of Medical Microbiology, Hanoi Medical University, 1 Ton That Tung street, Hanoi, Vietnam
| | - Ho D Phuc
- Department of Probability and Statistics, Institute of Mathematics, 18 Hoang Quoc Viet road, Hanoi, Vietnam
| | - Mattias Larsson
- Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Nobels väg 9, 171 77 Stockholm, Sweden
- Oxford University Clinical Research Unit, National Hospital of Tropical Diseases, 78 Giai Phong road, Dong Da district, Hanoi, Vietnam
| | - Nguyen TK Chuc
- Health System Research, Hanoi Medical University, 1 Ton That Tung street, Hanoi, Vietnam
| | - Cecilia Stålsby Lundborg
- Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Nobels väg 9, 171 77 Stockholm, Sweden
| |
Collapse
|
42
|
Dalhoff A. Resistance surveillance studies: a multifaceted problem--the fluoroquinolone example. Infection 2012; 40:239-62. [PMID: 22460782 DOI: 10.1007/s15010-012-0257-2] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 03/09/2012] [Indexed: 02/06/2023]
Abstract
INTRODUCTION This review summarizes data on the fluoroquinolone resistance epidemiology published in the previous 5 years. MATERIALS AND METHODS The data reviewed are stratified according to the different prescription patterns by either primary- or tertiary-care givers and by indication. Global surveillance studies demonstrate that fluoroquinolone- resistance rates increased in the past several years in almost all bacterial species except Staphylococcus pneumoniae and Haemophilus influenzae causing community-acquired respiratory tract infections (CARTIs), as well as Enterobacteriaceae causing community-acquired urinary tract infections. Geographically and quantitatively varying fluoroquinolone resistance rates were recorded among Gram-positive and Gram-negative pathogens causing healthcare-associated respiratory tract infections. One- to two-thirds of Enterobacteriaceae producing extended-spectrum β-lactamases (ESBLs) were fluoroquinolone resistant too, thus, limiting the fluoroquinolone use in the treatment of community- as well as healthcare-acquired urinary tract and intra-abdominal infections. The remaining ESBL-producing or plasmid-mediated quinolone resistance mechanisms harboring Enterobacteriaceae were low-level quinolone resistant. Furthermore, 10-30 % of H. influenzae and S. pneumoniae causing CARTIs harbored first-step quinolone resistance determining region (QRDR) mutations. These mutants pass susceptibility testing unnoticed and are primed to acquire high-level fluoroquinolone resistance rapidly, thus, putting the patient at risk. The continued increase in fluoroquinolone resistance affects patient management and necessitates changes in some current guidelines for the treatment of intra-abdominal infections or even precludes the use of fluoroquinolones in certain indications like gonorrhea and pelvic inflammatory diseases in those geographic areas in which fluoroquinolone resistance rates and/or ESBL production is high. Fluoroquinolone resistance has been selected among the commensal flora colonizing the gut, nose, oropharynx, and skin, so that horizontal gene transfer between the commensal flora and the offending pathogen as well as inter- and intraspecies recombinations contribute to the emergence and spread of fluoroquinolone resistance among pathogenic streptococci. Although interspecies recombinations are not yet the major cause for the emergence of fluoroquinolone resistance, its existence indicates that a large reservoir of fluoroquinolone resistance exists. Thus, a scenario resembling that of a worldwide spread of β-lactam resistance in pneumococci is conceivable. However, many resistance surveillance studies suffer from inaccuracies like the sampling of a selected patient population, restricted geographical sampling, and undefined requirements of the user, so that the results are biased. The number of national centers is most often limited with one to two participating laboratories, so that such studies are point prevalence but not surveillance studies. Selected samples are analyzed predominantly as either hospitalized patients or patients at risk or those in whom therapy failed are sampled; however, fluoroquinolones are most frequently prescribed by the general practitioner. Selected sampling results in a significant over-estimation of fluoroquinolone resistance in outpatients. Furthermore, the requirements of the users are often not met; the prescribing physician, the microbiologist, the infection control specialist, public health and regulatory authorities, and the pharmaceutical industry have diverse interests, which, however, are not addressed by different designs of a surveillance study. Tools should be developed to provide customer-specific datasets. CONCLUSION Consequently, most surveillance studies suffer from well recognized but uncorrected biases or inaccuracies. Nevertheless, they provide important information that allows the identification of trends in pathogen incidence and antimicrobial resistance.
Collapse
Affiliation(s)
- A Dalhoff
- Institute for Infection-Medicine, Christian-Albrechts University of Kiel and University Medical Center Schleswig-Holstein, Brunswiker Str. 4, 24105, Kiel, Germany.
| |
Collapse
|
43
|
Sahoo KC, Tamhankar AJ, Sahoo S, Sahu PS, Klintz SR, Lundborg CS. Geographical variation in antibiotic-resistant Escherichia coli isolates from stool, cow-dung and drinking water. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:746-59. [PMID: 22690160 PMCID: PMC3367274 DOI: 10.3390/ijerph9030746] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 02/20/2012] [Accepted: 02/28/2012] [Indexed: 11/16/2022]
Abstract
Little information is available on relationships between the biophysical environment and antibiotic resistance. This study was conducted to investigate the antibiotic resistance pattern of Escherichia coli isolated from child stool samples, cow-dung and drinking water from the non-coastal (230 households) and coastal (187 households) regions of Odisha, India. Susceptibility testing of E. coli isolates (n = 696) to the following antibiotics: tetracycline, ampicillin/sulbactam, cefuroxime, cefotaxime, cefixime, cotrimoxazole, amikacin, ciprofloxacin, norfloxacin and nalidixic acid was performed by the disk diffusion method. Ciprofloxacin minimum inhibitory concentration (MIC) values were determined for ciprofloxacin-resistant isolates (n = 83). Resistance to at least one antibiotic was detected in 90% or more of the E. coli isolates. Ciprofloxacin MIC values ranged from 8 to 32 µg/mL. The odds ratio (OR) of resistance in E. coli isolates from children’s stool (OR = 3.1, 95% CI 1.18–8.01), cow-dung (OR = 3.6, 95% CI 1.59–8.03, P = 0.002) and drinking water (OR = 3.8, 95% CI 1.00–14.44, P = 0.049) were higher in non-coastal compared to coastal region. Similarly, the co-resistance in cow-dung (OR = 2.5, 95% CI 1.39–4.37, P = 0.002) and drinking water (OR = 3.2, 95% CI 1.36–7.41, P = 0.008) as well as the multi-resistance in cow-dung (OR = 2.2, 95% CI 1.12–4.34, P = 0.022) and drinking water (OR = 2.7, 95% CI 1.06–7.07, P = 0.036) were also higher in the non-coastal compared to the coastal region.
Collapse
Affiliation(s)
- Krushna Chandra Sahoo
- Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Nobels väg 9, SE 171 77 Stockholm, Sweden; (S.R.K.); (C.S.L.)
- Author to whom correspondence should be addressed; ; ; Tel.: +46-0-8-524-83366; Fax: +46-8-311-590
| | - Ashok J. Tamhankar
- Indian Initiative for Management of Antibiotic Resistance (IIMAR), Department of Environmental Medicine, R.D. Gardi Medical College, Ujjain 456 006, India;
| | - Soumyakanta Sahoo
- Department of Microbiology, Super Religare Laboratories Limited, Kalinga Hospital, Bhubaneswar 751 023, India;
| | - Priyadarshi Soumyaranjan Sahu
- Department of Microbiology, Kalinga Institute of Medical Sciences and School of Biotechnology, KIIT University, Bhubaneswar 751 024, India;
| | - Senia Rosales Klintz
- Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Nobels väg 9, SE 171 77 Stockholm, Sweden; (S.R.K.); (C.S.L.)
| | - Cecilia Stålsby Lundborg
- Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Nobels väg 9, SE 171 77 Stockholm, Sweden; (S.R.K.); (C.S.L.)
| |
Collapse
|