Identification of risk factors associated with carriage of resistant Escherichia coli in three culturally diverse ethnic groups in Tanzania: a biological and socioeconomic analysis

Caudell, M. A., Mair, C., Subbiah, M., Matthews, L. , Quinlan, R. J., Zadoks, R. , Keyyu, J. and Call, D. R. (2018) 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 Planetary Health, 2(11), e489-e497. (doi:10.1016/S2542-5196(18)30225-0) (PMID:30396440) (PMCID:PMC6215761)

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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.

Item Type:Articles
Additional Information:In addition to the awards held at the University of Glasgow, this paper also acknowledges awards from the National Science Foundation (DEB 1216040) and the Allen School.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Mair, Miss Colette and Zadoks, Professor Ruth and Matthews, Professor Louise
Authors: Caudell, M. A., Mair, C., Subbiah, M., Matthews, L., Quinlan, R. J., Zadoks, R., Keyyu, J., and Call, D. R.
College/School:College of Medical Veterinary and Life Sciences > Institute of Biodiversity Animal Health and Comparative Medicine
College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
Journal Name:Lancet Planetary Health
Publisher:Elsevier
ISSN:2542-5196
ISSN (Online):2542-5196
Published Online:02 November 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in Lancet Planetary Health 2(11): e489-e497
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
569671Ecological and socioeconomic factors impacting maintenance and dissemination of antibiotic resistance in the Greater Serengeti EcosystemLouise MatthewsBiotechnology and Biological Sciences Research Council (BBSRC)BB/K01126X/1RI BIODIVERSITY ANIMAL HEALTH & COMPMED
627871Social, economic and environmental drivers of zoonoses in Tanzania (SEEDZ)Sarah CleavelandBiotechnology and Biological Sciences Research Council (BBSRC)BB/L018926/1RI BIODIVERSITY ANIMAL HEALTH & COMPMED
709011Quinquennial Core FundsMassimo PalmariniMedical Research Council (MRC)MC_UU_12014/9MVLS III - CENTRE FOR VIRUS RESEARCH