Identification of risk factors associated with carriage of resistant Escherichia coli in three culturally diverse ethnic groups in Tanzania: a biological and socioeconomic analysis.
Identification of risk factors associated with carriage of resistant Escherichia coli in three culturally diverse ethnic groups in Tanzania: a biological and socioeconomic analysis.
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DOI：
10.1016/s2542-5196(18)30225-0
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发表时间：
2018-11
期刊：
影响因子：
--
通讯作者：
Call DR
中科院分区：
文献类型：
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作者：
Caudell MA;Mair C;Subbiah M;Matthews L;Quinlan RJ;Quinlan MB;Zadoks R;Keyyu J;Call DR
改进抗菌药物管理、环境卫生和个人卫生是世卫组织为限制抗菌药物耐药性传播而提出的优先事项。优先考虑这些目标至关重要，特别是在低收入和中等收入国家，但导致抗生素耐药性最大的因素通常是未知的，并且在国家之间和国家内部可能存在很大差异。我们的目的是确定与坦桑尼亚北方三个不同文化的民族携带耐药大肠杆菌相关的生物学和社会经济学风险因素。我们制定了一项包含200多个项目的调查，并根据种族组成和与城市中心的距离，在查加、阿鲁沙或马赛的13个村庄随机选择家庭进行调查。从一部分家庭中收集人类粪便样本，以及液态奶样本和牛奶容器拭子。处理样品并接种到麦康凯琼脂平板上，然后根据菌落形态鉴定推定的大肠杆菌分离株。然后通过折点试验检测分离株对一组9种抗菌剂（氨苄西林、头孢他啶、氯霉素、环丙沙星、卡那霉素、链霉素、磺胺甲恶唑、四环素和甲氧苄啶）的敏感性。易感性调查结果与广泛的家庭特征数据相匹配，包括教育，卫生习惯，财富，畜牧业和抗生素使用。在2012年3月23日至2015年7月30日期间，我们采访了391户家庭（阿鲁沙118户，查加100户和马赛173户）。在13个村庄的226个（58%）家庭中收集了人类粪便样本。从7个村庄的117个家庭收集了181份牛奶样本和191份牛奶容器拭子。 从粪便样品中分离出11470份推定的大肠杆菌样品。人和牲畜的抗菌药物使用与家庭层面的耐药性流行无关。相反，具有最大预测价值的因素涉及接触细菌，并且与研究组之间的基本文化差异密切相关。这些因素包括不同的生计类型（牧民与农民）如何获得水源和未煮牛奶的消费，反映了牛奶中耐药细菌的增加。当文化和生态条件有利于细菌传播时，人们很有可能藏匿耐药性细菌，而不管抗菌剂的使用习惯如何。限制抗生素耐药性的公共卫生干预措施需要根据影响细菌传播的当地做法进行调整。美国国家科学基金会、生物技术和生物科学研究理事会、英国医学研究理事会和艾伦学院。
Improved antimicrobial stewardship, sanitation, and hygiene are WHO-inspired priorities for restriction of the spread of antimicrobial resistance. Prioritisation among these objectives is essential, particularly in low-income and middle-income countries, but the factors contributing most to antimicrobial resistance are typically unknown and could vary substantially between and within countries. We aimed to identify the biological and socioeconomic risk factors associated with carriage of resistant Escherichia coli in three culturally diverse ethnic groups in northern Tanzania. We developed a survey containing more than 200 items and administered it in randomly selected households in 13 Chagga, Arusha, or Maasai villages chosen on the basis of ethnic composition and distance to urban centres. Human stool samples were collected from a subset of households, as were liquid milk samples and swabs of milk containers. Samples were processed and plated onto MacConkey agar plates, then presumptive E coli isolates were identified on the basis of colony morphology. Susceptibility of isolates was then tested against a panel of nine antimicrobials (ampicillin, ceftazidime, chloramphenicol, ciprofloxacin, kanamycin, streptomycin, sulfamethoxazole, tetracycline, and trimethoprim) via a breakpoint assay. Susceptibility findings were matched with data across a wide range of household characteristics, including education, hygiene practices, wealth, livestock husbandry, and antibiotic use. Between March 23, 2012, and July 30, 2015, we interviewed 391 households (118 Arusha, 100 Chagga, and 173 Maasai). Human stool samples were collected at 226 (58%) households across the 13 villages. 181 milk samples and 191 milk-container swabs were collected from 117 households across seven villages. 11 470 putative E coli samples were isolated from stool samples. Antimicrobial use in people and livestock was not associated with prevalence of resistance at the household level. Instead, the factors with the greatest predictive value involved exposure to bacteria, and were intimately connected with fundamental cultural differences across study groups. These factors included how different subsistence types (pastoralists vs farmers) access water sources and consumption of unboiled milk, reflecting increased exposure to resistant bacteria in milk. When cultural and ecological conditions favour bacterial transmission, there is a high likelihood that people will harbour antimicrobial-resistant bacteria irrespective of antimicrobial use practices. Public health interventions to limit antimicrobial resistance need to be tailored to local practices that affect bacterial transmission. US National Science Foundation; Biotechnology and Biological Sciences Research Council, UK Medical Research Council; and the Allen School.