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

Molly E. Fleece Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia;

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Rosemary Nshama Haydom Global Health Institute, Haydom, Tanzania

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Thomas Walongo Haydom Global Health Institute, Haydom, Tanzania

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Caroline Kimathi Haydom Global Health Institute, Haydom, Tanzania

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Jean Gratz Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia;

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Elizabeth T. Rogawski McQuade Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia;

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Jie Liu Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia;

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Suporn Pholwat Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia;

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Esto Mduma Haydom Global Health Institute, Haydom, Tanzania

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Eric R. Houpt Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia;

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James A. Platts-Mills Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia;

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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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