Varying high levels of faecal carriage of extended-spectrum beta-lactamase producing Enterobacteriaceae in rural villages in Shandong, China: implications for global health.

Qiang Sun,Malin Grape,Maria Tärnberg,Lennart E Nilsson,Göran Tomson,Cecilia Stålsby Lundborg,Maud Nilsson,Yanyan Song,Lingbo Zhao

doi:10.1371/journal.pone.0113121

Abstract

Antibiotic resistance is considered a major threat to global health and is affected by many factors, of which antibiotic use is probably one of the more important. Other factors include hygiene, crowding and travel. The rapid resistance spread in Gram-negative bacteria, in particular extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae (ESBL-E), is a global challenge, leading to increased mortality, morbidity and health systems costs worldwide. Knowledge about resistance in commensal flora is limited, including in China. Our aim was to establish the faecal carriage rates of ESBL-E and find its association with known and suspected risk factors in rural residents of all ages in three socio-economically different counties in the Shandong Province, China. Faecal samples and risk-factor information (questionnaire) were collected in 2012. ESBL-E carriage was screened using ChromID ESBL agar. Risk factors were analysed using standard statistical methods. Data from 1000 individuals from three counties and in total 18 villages showed a high and varying level of ESBL-E carriage. Overall, 42% were ESBL-E carriers. At county level the carriage rates were 49%, 45% and 31%, respectively, and when comparing individual villages (n = 18) the rate varied from 22% to 64%. The high level of ESBL-E carriage among rural residents in China is an indication of an exploding global challenge in the years to come as resistance spreads among bacteria and travels around the world with the movement of people and freight. A high carriage rate of ESBL-E increases the risk of infection with multi-resistant bacteria, and thus the need for usage of last resort antibiotics, such as carbapenems and colistin, in the treatment of common infections.

Highlights

The faceless threat of antibiotic resistance is one of the greatest challenges of this century [1] and is considered one of the three major threats to global health by the WHO. [2] Overuse and irrational use of antibiotics, both in human and veterinary medicine, are considered driving forces [3].The rapidly increasing resistance in Gram-negative bacteria is a serious problem worldwide, leading to increased mortality, morbidity and health systems costs. [2,4,5] The production of extended-spectrum beta-lactamases (ESBLs) in Enterobacteriaceae (ESBL-E) causes resistance to third-generation cephalosporins, one of the most important and widely used antibiotic classes
The aim of this study was to establish the faecal carriage rates of ESBL-E and its association with several known and suspected risk factors, in rural residents of all ages in three socio-economically different counties in Shandong Province, China. To our knowledge this is the largest study of faecal carriage of ESBL-E performed in China
We found no evident risk factors associated with this high carriage rate, but the statistical analysis indicates that the use of antibiotics may be one part of the explanation

Summary

Introduction

The faceless threat of antibiotic resistance is one of the greatest challenges of this century [1] and is considered one of the three major threats to global health by the WHO. [2] Overuse and irrational use of antibiotics, both in human and veterinary medicine, are considered driving forces [3].The rapidly increasing resistance in Gram-negative bacteria is a serious problem worldwide, leading to increased mortality, morbidity and health systems costs. [2,4,5] The production of extended-spectrum beta-lactamases (ESBLs) in Enterobacteriaceae (ESBL-E) causes resistance to third-generation cephalosporins, one of the most important and widely used antibiotic classes. The faceless threat of antibiotic resistance is one of the greatest challenges of this century [1] and is considered one of the three major threats to global health by the WHO. The rapidly increasing resistance in Gram-negative bacteria is a serious problem worldwide, leading to increased mortality, morbidity and health systems costs. [2,4,5] The production of extended-spectrum beta-lactamases (ESBLs) in Enterobacteriaceae (ESBL-E) causes resistance to third-generation cephalosporins, one of the most important and widely used antibiotic classes. Asymptomatic faecal carriage of ESBL-producing bacteria in the community has been reported from several countries and continents with wide differences in carriage rates between geographic areas and study population characteristics. Very high faecal prevalence rates have recently been reported from Thailand (66%), Egypt (63%) and China (50%). Very high faecal prevalence rates have recently been reported from Thailand (66%), Egypt (63%) and China (50%). [7,8,9] In comparison, very low levels of carriage (3%) have recently been reported from Sweden [10]

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Conclusion