Antibiotic use and hygiene interact to influence the distribution of antimicrobial-resistant bacteria in low-income communities in Guatemala

Brooke M Ramay,Sylvia Omulo,Purificación Moreno,Ofer Amram,Douglas R Call,Claudia Jarquin,John P Mccracken,Guy H Palmer,Mark A Caudell,Celia Cordón-Rosales,L Diego Archila,Leah Rosenkrantz

doi:10.1038/s41598-020-70741-4

Abstract

To examine the effects of poor sanitation and hygiene on the prevalence of antimicrobial-resistant bacteria, we surveyed households in two rural and two urban communities in Guatemala (N = 196 randomly selected households). One adult (≥ 18-years old) and, when available, one child (≤ 5 years-old) provided a stool sample. Up to 48 presumptive Escherichia coli isolates were collected from each stool sample (n = 21,256 total) and were subjected to breakpoint assays for ten antibiotics. Mixed-effects logistic models were used to identify potential factors influencing the likelihood of harboring antibiotic-resistant bacteria. For nine out of ten antibiotics, the odds of detecting resistant bacteria decreased by ~ 32% (odds ratios, OR 0.53–0.8, P < 0.001) for every unit of improvement of a hygiene scale. Hygiene differences between households had a greater impact on prevalence compared to antibiotic use differences. The likelihood of detecting resistant isolates was lower for five antibiotics among households that boiled raw milk before consumption (OR 0.31–0.69), and higher for nine antibiotics in urban households (OR > 1.89–9.6). Poor hygiene conditions likely obscure effects of individual antibiotic use, presumably due to enhanced microbial transmission. Consequently, efforts to improve antibiotic stewardship should be coupled with improving hygiene conditions.

Highlights

Antimicrobial-resistant infections contribute to hundreds-of-thousands of deaths w orldwide[1]
To test how antibiotic use and transmission factors interact to influence the distribution of antimicrobialresistant bacteria in communities where these factors vary, we studied the distribution of antibiotic-resistant Escherichia coli in four communities from the western highlands and lowlands of Guatemala
Stool samples were obtained from 195 adults and 78 children accounting for 273 individuals from 196 households provided 480 stool samples collected during the study period

Summary

Introduction

Antimicrobial-resistant infections contribute to hundreds-of-thousands of deaths w orldwide[1] To address this threat, public and private organizations are engaged in programs to improve surveillance for antimicrobialresistant organisms, to improve antibiotic stewardship, and to identify novel therapeutics, all of which are considered priority actions for combating antimicrobial resistance (AMR)[2,3,4]. Indicators of transmission, including access to clean water[5] and open defecation[6] This lack of association between antibiotic use and AMR in some settings may result from conditions in less-wealthy countries where the prevalence of antimicrobial resistance is more closely correlated with general transmission of b acteria[16]. To test how antibiotic use and transmission factors interact to influence the distribution of antimicrobialresistant bacteria in communities where these factors vary, we studied the distribution of antibiotic-resistant Escherichia coli in four communities from the western highlands and lowlands of Guatemala. If there is a significant interaction between antibiotic use and transmission factors, this has important implications for how public health policies should direct resources to limit the prevalence of antibiotic-resistant bacteria in these communities

Methods

Results

Conclusion