Abstract
There are substantial limitations in understanding of the distribution of antimicrobial resistance (AMR) in humans and livestock in developing countries. This papers present the results of an epidemiological study examining patterns of AMR in Escherichia coli isolates circulating in sympatric human (n = 321) and livestock (n = 633) samples from 99 households across Nairobi, Kenya. E. coli isolates were tested for susceptibility to 13 antimicrobial drugs representing nine antibiotic classes. High rates of AMR were detected, with 47.6% and 21.1% of isolates displaying resistance to three or more and five or more antibiotic classes, respectively. Human isolates showed higher levels of resistance to sulfonamides, trimethoprim, aminoglycosides and penicillins compared with livestock (P<0.01), while poultry isolates were more resistant to tetracyclines (P = 0.01) compared with humans. The most common co-resistant phenotype observed was to tetracyclines, streptomycin and trimethoprim (30.5%). At the household level, AMR carriage in humans was associated with human density (P<0.01) and the presence of livestock manure (P = 0.03), but keeping livestock had no influence on human AMR carriage (P>0.05). These findings revealed a high prevalence of AMR E. coli circulating in healthy humans and livestock in Nairobi, with no evidence to suggest that keeping livestock, when treated as a single risk factor, contributed significantly to the burden of AMR in humans, although the presence of livestock waste was significant. These results provide an understanding of the broader epidemiology of AMR in complex and interconnected urban environments.
Highlights
Antimicrobial resistance (AMR) in bacteria is regarded as one of the most serious public health threats of this century [1,2,3]
This paper reports the results from the first study to characterize the patterns and epidemiology of antibiotic-resistant E. coli from cohabiting human and livestock populations in a lowresource urban setting
Whilst direct host-to-host transmission of AMR bacteria and AMR determinants may occur, in these intricate ecosystems, the role played by the wider environment in relation to acquisition of AMR from a common source may be vital. This rigorously structured epidemiological study found a high prevalence of AMR E. coli carriage in livestock and humans outside the clinical setting across a developing country urban landscape, with no evidence that direct contact with livestock contributes to the burden of human AMR, but that indirect contact between livestock and humans does play a role
Summary
Antimicrobial resistance (AMR) in bacteria is regarded as one of the most serious public health threats of this century [1,2,3]. Over the last decade, increasing levels of resistance to clinically relevant antibiotics – including carbapenems [4] and colistin [5], which are considered antibiotics of last resort – have been reported in both human and animal populations. Escherichia coli can be a harmless gut commensal, some pathogenic strains can cause life-threatening bloodstream infections and common illnesses, such as urinary tract infections [6]. E. coli can cause disease in animals, leading to severe economic losses due to mortality and morbidity [7]. E. coli was categorized by the World Health Organization as a priority pathogen due to its widespread antibiotic resistance [8]. Ward et al / International Journal of Antimicrobial Agents 54 (2019) 531–537
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