• 1.

    O’Neill J, 2014. Tackling Drug-Resistant Infections Globally: Final Report and Recommendations. The Review on Antimicrobial Resistance. Available at: https://amr-review.org/Publications.html. Accessed September 28, 2018.

    • Search Google Scholar
    • Export Citation
  • 2.

    World Health Organization, 2017. Global Priority List of Antibiotic-Resistant Bacteria to Guide Research, Discovery, and Development of New Antibiotics. Available at: http://www.who.int/medicines/publications/global-priority-list-antibiotic-resistant-bacteria/en/. Accessed September 28, 2018.

    • Search Google Scholar
    • Export Citation
  • 3.

    Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, Cousens S, Mathers C, Black RE, 2015. Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 385: 430440.

    • Search Google Scholar
    • Export Citation
  • 4.

    Laxminarayan R, Matsoso P, Pant S, Brower C, Rottingen JA, Klugman K, Davies S, 2016. Access to effective antimicrobials: a worldwide challenge. Lancet 387: 168175.

    • Search Google Scholar
    • Export Citation
  • 5.

    Investigators of the Delhi Neonatal Infection Study (DeNIS) Collaboration, 2016. Characterisation and antimicrobial resistance of sepsis pathogens in neonates born in tertiary care centres in Delhi, India: a cohort study. Lancet Glob Health 4: e752e760.

    • Search Google Scholar
    • Export Citation
  • 6.

    Kayange N, Kamugisha E, Mwizamholya DL, Jeremiah S, Mshana SE, 2010. Predictors of positive blood culture and deaths among neonates with suspected neonatal sepsis in a tertiary hospital, Mwanza-Tanzania. BMC Pediatr 10: 39.

    • Search Google Scholar
    • Export Citation
  • 7.

    Fox-Lewis A et al. 2018. Antimicrobial resistance in invasive bacterial infections in hospitalized children, Cambodia, 2007–2016. Emerg Infect Dis 24: 841851.

    • Search Google Scholar
    • Export Citation
  • 8.

    Bailey JK, Pinyon JL, Anantham S, Hall RM, 2010. Commensal Escherichia coli of healthy humans: a reservoir for antibiotic-resistance determinants. J Med Microbiol 59: 13311339.

    • Search Google Scholar
    • Export Citation
  • 9.

    Klemm EJ et al. 2018. Emergence of an extensively drug-resistant Salmonella enterica serovar typhi clone harboring a promiscuous plasmid encoding resistance to fluoroquinolones and third-generation cephalosporins. MBio 9: e00105-18.

    • Search Google Scholar
    • Export Citation
  • 10.

    Turner P, Pol S, Soeng S, Sar P, Neou L, Chea P, Day NP, Cooper BS, Turner C, 2016. High prevalence of antimicrobial-resistant gram-negative colonization in hospitalized Cambodian infants. Pediatr Infect Dis J 35: 856861.

    • Search Google Scholar
    • Export Citation
  • 11.

    Das P, Singh AK, Pal T, Dasgupta S, Ramamurthy T, Basu S, 2011. Colonization of the gut with Gram-negative bacilli, its association with neonatal sepsis and its clinical relevance in a developing country. J Med Microbiol 60: 16511660.

    • Search Google Scholar
    • Export Citation
  • 12.

    Richard SA, Barrett LJ, Guerrant RL, Checkley W & Miller MA MAL-ED Network Investigators, 2014. Disease surveillance methods used in the 8-site MAL-ED cohort study. Clin Infect Dis 59: S220S224.

    • Search Google Scholar
    • Export Citation
  • 13.

    Houpt E et al. MAL-ED Network Investigators, 2014. Microbiologic methods utilized in the MAL-ED cohort study. Clin Infect Dis 59: S225S232.

  • 14.

    Mduma ER et al. 2014. The etiology, risk factors, and interactions of enteric infections and malnutrition and the consequences for child health and development study (MAL-ED): description of the Tanzanian site. Clin Infect Dis 59: S325S330.

    • Search Google Scholar
    • Export Citation
  • 15.

    Clinical and Laboratory Standards Institute (CLSI), 2016. Performance Standards for Antimicrobial Susceptbility Testing. Twenty-Sixth Informational Supplement. M100-S26. Wayne, PA: CLSI.

    • Search Google Scholar
    • Export Citation
  • 16.

    Seidman JC, Coles CL, Silbergeld EK, Levens J, Mkocha H, Johnson LB, Munoz B, West SK, 2014. Increased carriage of macrolide-resistant fecal E. coli following mass distribution of azithromycin for trachoma control. Int J Epidemiol 43: 11051113.

    • Search Google Scholar
    • Export Citation
  • 17.

    Roschanski N, Fischer J, Guerra B, Roesler U, 2014. Development of a multiplex real-time PCR for the rapid detection of the predominant beta-lactamase genes CTX-M, SHV, TEM and CIT-type AmpCs in Enterobacteriaceae. PLoS One 9: e100956.

    • Search Google Scholar
    • Export Citation
  • 18.

    Magiorakos AP et al. 2012. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 18: 268281.

    • Search Google Scholar
    • Export Citation
  • 19.

    Tadesse BT, Ashley EA, Ongarello S, Havumaki J, Wijegoonewardena M, Gonzalez IJ, Dittrich S, 2017. Antimicrobial resistance in Africa: a systematic review. BMC Infect Dis 17: 616.

    • Search Google Scholar
    • Export Citation
  • 20.

    Mathur S, Fuchs A, Bielicki J, Van Den Anker J, Sharland M, 2018. Antibiotic use for community-acquired pneumonia in neonates and children: WHO evidence review. Paediatr Int Child Health 38(Supp 1): S66S75.

    • Search Google Scholar
    • Export Citation
  • 21.

    Backhed F et al. 2015. Dynamics and stabilization of the human gut microbiome during the first year of life. Cell Host Microbe 17: 690703.

  • 22.

    Rogawski ET et al. 2017. Use of antibiotics in children younger than two years in eight countries: a prospective cohort study. Bull World Health Organ 95: 4961.

    • Search Google Scholar
    • Export Citation
  • 23.

    Chen S, Larsson M, Robinson RC, Chen SL, 2017. Direct and convenient measurement of plasmid stability in lab and clinical isolates of E. coli. Sci Rep 7: 4788.

    • Search Google Scholar
    • Export Citation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 

 

Longitudinal Assessment of Antibiotic Resistance in Fecal Escherichia coli in Tanzanian Children

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  • 1 Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia;
  • | 2 Haydom Global Health Institute, Haydom, Tanzania
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Antibiotic-resistant bacterial infections are a major public health problem, and children in low-resource settings represent a particularly high-risk group. Few data are available on the dynamics of and risk factors for gastrointestinal carriage of antibiotic-resistant bacteria in these vulnerable populations. In this study, we described the antibiotic susceptibility profiles of Escherichia coli isolated from stool specimens collected from children aged 6 to 60 months enrolled in a birth cohort study in Haydom, Tanzania. We estimated the association between sociodemographic risk factors, child illnesses, and antibiotic exposure and E. coli drug resistance. Carriage of antibiotic-resistant E. coli was common starting early in life and did not clearly increase with age. The majority of isolates were resistant to ampicillin (749/837; 89.5%), cefazolin (742/837; 88.6%), and cotrimoxazole (721/837; 86.1%). Resistance to amoxicillin/clavulanate (361/836; 43.2%), ampicillin/sulbactam (178/819; 21.7%), nalidixic acid (131/831; 15.8%), and azithromycin (115/837; 13.7%) was also seen. Only 1.8% (15/837) of the pooled E. coli isolates met the criteria for extended-spectrum beta-lactamase production. High antibiotic use (0.26 additional resistant antibiotic classes; 95% CI: 0.05, 0.47) and high income (0.28 additional resistant antibiotic classes; 95% CI: 0.06, 0.50) were associated with the carriage of antibiotic-resistant E. coli, whereas hospital birth, crowding in the home, improved drinking water and sanitation, and common childhood illnesses were not. In this setting, the carriage of antibiotic-resistant E. coli was common. Other than recent antibiotic exposure and high income, individual risk factors for the acquisition and carriage of resistance could not be identified, suggesting that population-level interventions are needed.

Author Notes

Address correspondence to James A. Platts-Mills, Division of Infectious Diseases and International Health, University of Virginia, P.O. Box 801340, Charlottesville, VA 22908. E-mail: jp5t@virginia.edu

Financial support: Supported by NIH K24 AI102972 to E. H.; NIH K23 AI114888 to J. A. P.-M.; and NIH T32 AI007046-42 to M. E. F.

Authors’ addresses: Molly E. Fleece, Jean Gratz, Elizabeth T. Rogawski McQuade, Jie Liu, Suporn Pholwat, Eric R. Houpt, and James A. Platts-Mills, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, E-mails: mef8w@hscmail.mcc.virginia.edu, jean.gratz@gmail.com, etr5m@virginia.edu, jl5yj@virginia.edu, sp4vs@virginia.edu, erh6k@virginia.edu, and jp5t@virginia.edu. Rosemary Nshama, Thomas Walongo, Caroline Kimathi, and Esto Mduma, Haydom Global Health Institute, Haydom, Tanzania, E-mails: nshamarosemary@gmail.com, walongoisthomas@gmail.com, carolinekimathi27@gmail.com, and esto@haydom.co.tz.

These authors contributed equally to this work.

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