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

• Published in: The American journal of tropical medicine and hygiene 2019-05, Vol.100 (5), p.1110-1114
• Main Authors: Fleece, Molly E, Nshama, Rosemary, Walongo, Thomas, Kimathi, Caroline, Gratz, Jean, Rogawski McQuade, Elizabeth T, Liu, Jie, Pholwat, Suporn, Mduma, Esto, Houpt, Eric R, Platts-Mills, James A
• Format: Article
• Language: English
• Subjects: Age Factors; Anti-Bacterial Agents - pharmacology; Antibiotics; Asymptomatic Infections - epidemiology; beta-Lactamases - genetics; Child, Preschool; Drug resistance; Drug Resistance, Multiple, Bacterial; E coli; Escherichia coli - drug effects; Escherichia coli - enzymology; Escherichia coli Infections - epidemiology; Escherichia coli Infections - microbiology; Feces - microbiology; Female; Humans; Infant; Longitudinal Studies; Male; Microbial Sensitivity Tests; Risk Factors; Socioeconomic Factors; Tanzania - epidemiology
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.18-0789

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 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 drug resistance. Carriage of antibiotic-resistant 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 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 , 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 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.