Sylvia Omulo1,2,3, Eric T Lofgren4, Svetlana Lockwood4, Samuel M Thumbi4,5,6, Godfrey Bigogo6, Alice Ouma6, Jennifer R Verani7, Bonventure Juma7, M Kariuki Njenga4,5, Samuel Kariuki7, Terry F McElwain4,8, Guy H Palmer4,5,8, Douglas R Call4,5,8. 1. Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA. sylvia.omulo@wsu.edu. 2. Washington State University Global Health-Kenya, Nairobi, Kenya. sylvia.omulo@wsu.edu. 3. Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya. sylvia.omulo@wsu.edu. 4. Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA. 5. Washington State University Global Health-Kenya, Nairobi, Kenya. 6. Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya. 7. Centers for Disease Control and Prevention, Nairobi, Kenya. 8. Nelson Mandela African Institution for Science and Technology, Arusha, Tanzania.
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.
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.
Entities:
Keywords:
Antimicrobial resistance; E. coli; Informal settlement; Kenya; Sanitation
Authors: Michael A Borg; Peter Zarb; Elizabeth A Scicluna; Ossama Rasslan; Deniz Gür; Saida Ben Redjeb; Ziad Elnasser; Ziad Daoud Journal: Am J Infect Control Date: 2009-11-08 Impact factor: 2.918
Authors: Beatrice Olack; Heather Burke; Leonard Cosmas; Sapna Bamrah; Kathleen Dooling; Daniel R Feikin; Leisel E Talley; Robert F Breiman Journal: J Health Popul Nutr Date: 2011-08 Impact factor: 2.000
Authors: Robert F Breiman; Leonard Cosmas; M Njenga; John Williamson; Joshua A Mott; Mark A Katz; Dean D Erdman; Eileen Schneider; M Oberste; John C Neatherlin; Henry Njuguna; Daniel M Ondari; Kennedy Odero; George O Okoth; Beatrice Olack; Newton Wamola; Joel M Montgomery; Barry S Fields; Daniel R Feikin Journal: BMC Infect Dis Date: 2015-02-25 Impact factor: 3.090
Authors: Mark A Caudell; Marsha B Quinlan; Murugan Subbiah; Douglas R Call; Casey J Roulette; Jennifer W Roulette; Adam Roth; Louise Matthews; Robert J Quinlan Journal: PLoS One Date: 2017-01-26 Impact factor: 3.240
Authors: Henry N Njuguna; Joel M Montgomery; Leonard Cosmas; Newton Wamola; Joseph O Oundo; Meghna Desai; Ann M Buff; Robert F Breiman Journal: Am J Trop Med Hyg Date: 2015-11-23 Impact factor: 2.345
Authors: Brooke M Ramay; Mark A Caudell; Celia Cordón-Rosales; L Diego Archila; Guy H Palmer; Claudia Jarquin; Purificación Moreno; John P McCracken; Leah Rosenkrantz; Ofer Amram; Sylvia Omulo; Douglas R Call Journal: Sci Rep Date: 2020-08-13 Impact factor: 4.379
Authors: Gilbert K Kikwai; Bonventure Juma; Fredrick Nindo; Caroline Ochieng; Newton Wamola; Kevin Mbogo; Douglas R Call; Elizabeth Hunsperger Journal: Microbiol Resour Announc Date: 2022-03-28