Antimicrobial Resistance in Humans, Animals, Water and Household Environs in Rural Andean Peru: Exploring Dissemination Pathways through the One Health Lens.

Stella M Hartinger,Hector Verastegui,Gabriela Salmon-Mulanovich,Maria Luisa Medina-Pizzali,María Pinedo-Bardales,Daniel Mäusezahl,Anika J Larson,Maribel Riberos

doi:10.3390/ijerph18094604

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.

Highlights

Antimicrobial resistance (AMR) has been labelled a public health threat, for developing economies [1]
We aimed to investigate the presence of AMR thermotolerant coliforms (i.e., E. coli, Klebsiella, Enterobacter, Citrobacter) in humans, environments like community water sources, household environments, and domestic animals of subsistence farmers; and to propose carriage and dissemination routes of AMR bacteria in the household environment
Our finding of thermotolerant coliforms in the reservoir’s water indicates recent fecal contamination [48]. 34.6% of reservoir water samples were positive for thermotolerant coliforms, with counts above the Peruvian and World Health Organization (WHO) threshold guidelines

Summary

Introduction

Antimicrobial resistance (AMR) has been labelled a public health threat, for developing economies [1]. Treatment failures caused by AMR result in an increased risk of mortality and unnecessary burden to healthcare infrastructure, among others [2,3]. Escherichia coli (E. coli)—and other commensal and enteric bacteria—may play a key role in the propagation of AMR genes. [7] Since fecal microbiota serves as the reservoir of these genes [8], which could be transferred to pathogenic organisms [9], the risk for resistant infections in the community increases. Multiple studies in Peru reported growing rates of AMR in commensal and enteric bacteria [10,11,12]. Many AMR genes significant in clinical settings are believed to have originated from non-pathogenic bacteria [13]

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