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Risk Factors, Temporal Dependence, and Seasonality of Human Extended-Spectrum β-Lactamases-Producing Escherichia coli and Klebsiella pneumoniae Colonization in Malawi: A Longitudinal Model-Based Approach

BACKGROUND: Sub-Saharan Africa has the highest estimated death rate attributable to antimicrobial resistance, especially from extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E). However, the dynamics of human colonization in the community with ESBL-E are not well described. Inadequate...

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Autores principales: Sammarro, Melodie, Rowlingson, Barry, Cocker, Derek, Chidziwisano, Kondwani, Jacob, Shevin T, Kajumbula, Henry, Mugisha, Lawrence, Musoke, David, Lester, Rebecca, Morse, Tracy, Feasey, Nicholas, Jewell, Chris
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10320086/
https://www.ncbi.nlm.nih.gov/pubmed/36869813
http://dx.doi.org/10.1093/cid/ciad117
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author Sammarro, Melodie
Rowlingson, Barry
Cocker, Derek
Chidziwisano, Kondwani
Jacob, Shevin T
Kajumbula, Henry
Mugisha, Lawrence
Musoke, David
Lester, Rebecca
Morse, Tracy
Feasey, Nicholas
Jewell, Chris
author_facet Sammarro, Melodie
Rowlingson, Barry
Cocker, Derek
Chidziwisano, Kondwani
Jacob, Shevin T
Kajumbula, Henry
Mugisha, Lawrence
Musoke, David
Lester, Rebecca
Morse, Tracy
Feasey, Nicholas
Jewell, Chris
author_sort Sammarro, Melodie
collection PubMed
description BACKGROUND: Sub-Saharan Africa has the highest estimated death rate attributable to antimicrobial resistance, especially from extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E). However, the dynamics of human colonization in the community with ESBL-E are not well described. Inadequate water, sanitation, and hygiene infrastructure and associated behaviors are believed to play an important role in transmission of ESBL-E, and an improved understanding of the temporal dynamics of within-household transmission could help inform the design of future policies. METHODS: In this 18-month study, using microbiological data and household surveys, we built a multivariable hierarchical harmonic logistic regression model to identify risk factors for colonization with ESBL-producing Escherichia coli and Klebsiella pneumoniae, reflecting household structure and temporal correlation of colonization status. RESULTS: Being male was associated with a lower risk of colonization with ESBL-producing E. coli (odds ratio [OR], 0.786; credible interval [CrI], .678–.910), whereas the use of a tube well or a borehole was associated with an increased risk (OR, 1.550; CrI, 1.003–2.394). For ESBL-producing K. pneumoniae, recent antibiotic exposure increased risk of colonization (OR, 1.281; CrI, 1.049–1.565), whereas sharing plates decreased that risk (OR, 0.672; CrI, .460–.980). Finally, the temporal correlation range of 8 to 11 weeks provided evidence that within-household transmission occurs within this time frame. CONCLUSIONS: We describe different risks for colonization with different enteric bacterial species. Our findings suggest interventions to reduce transmission targeted at the household level need to focus on improving water, sanitation, and hygiene infrastructure and associated behaviors, whereas at the community level, they should focus on both environmental hygiene and antibiotic stewardship.
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spelling pubmed-103200862023-07-06 Risk Factors, Temporal Dependence, and Seasonality of Human Extended-Spectrum β-Lactamases-Producing Escherichia coli and Klebsiella pneumoniae Colonization in Malawi: A Longitudinal Model-Based Approach Sammarro, Melodie Rowlingson, Barry Cocker, Derek Chidziwisano, Kondwani Jacob, Shevin T Kajumbula, Henry Mugisha, Lawrence Musoke, David Lester, Rebecca Morse, Tracy Feasey, Nicholas Jewell, Chris Clin Infect Dis Major Article BACKGROUND: Sub-Saharan Africa has the highest estimated death rate attributable to antimicrobial resistance, especially from extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E). However, the dynamics of human colonization in the community with ESBL-E are not well described. Inadequate water, sanitation, and hygiene infrastructure and associated behaviors are believed to play an important role in transmission of ESBL-E, and an improved understanding of the temporal dynamics of within-household transmission could help inform the design of future policies. METHODS: In this 18-month study, using microbiological data and household surveys, we built a multivariable hierarchical harmonic logistic regression model to identify risk factors for colonization with ESBL-producing Escherichia coli and Klebsiella pneumoniae, reflecting household structure and temporal correlation of colonization status. RESULTS: Being male was associated with a lower risk of colonization with ESBL-producing E. coli (odds ratio [OR], 0.786; credible interval [CrI], .678–.910), whereas the use of a tube well or a borehole was associated with an increased risk (OR, 1.550; CrI, 1.003–2.394). For ESBL-producing K. pneumoniae, recent antibiotic exposure increased risk of colonization (OR, 1.281; CrI, 1.049–1.565), whereas sharing plates decreased that risk (OR, 0.672; CrI, .460–.980). Finally, the temporal correlation range of 8 to 11 weeks provided evidence that within-household transmission occurs within this time frame. CONCLUSIONS: We describe different risks for colonization with different enteric bacterial species. Our findings suggest interventions to reduce transmission targeted at the household level need to focus on improving water, sanitation, and hygiene infrastructure and associated behaviors, whereas at the community level, they should focus on both environmental hygiene and antibiotic stewardship. Oxford University Press 2023-03-04 /pmc/articles/PMC10320086/ /pubmed/36869813 http://dx.doi.org/10.1093/cid/ciad117 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Major Article
Sammarro, Melodie
Rowlingson, Barry
Cocker, Derek
Chidziwisano, Kondwani
Jacob, Shevin T
Kajumbula, Henry
Mugisha, Lawrence
Musoke, David
Lester, Rebecca
Morse, Tracy
Feasey, Nicholas
Jewell, Chris
Risk Factors, Temporal Dependence, and Seasonality of Human Extended-Spectrum β-Lactamases-Producing Escherichia coli and Klebsiella pneumoniae Colonization in Malawi: A Longitudinal Model-Based Approach
title Risk Factors, Temporal Dependence, and Seasonality of Human Extended-Spectrum β-Lactamases-Producing Escherichia coli and Klebsiella pneumoniae Colonization in Malawi: A Longitudinal Model-Based Approach
title_full Risk Factors, Temporal Dependence, and Seasonality of Human Extended-Spectrum β-Lactamases-Producing Escherichia coli and Klebsiella pneumoniae Colonization in Malawi: A Longitudinal Model-Based Approach
title_fullStr Risk Factors, Temporal Dependence, and Seasonality of Human Extended-Spectrum β-Lactamases-Producing Escherichia coli and Klebsiella pneumoniae Colonization in Malawi: A Longitudinal Model-Based Approach
title_full_unstemmed Risk Factors, Temporal Dependence, and Seasonality of Human Extended-Spectrum β-Lactamases-Producing Escherichia coli and Klebsiella pneumoniae Colonization in Malawi: A Longitudinal Model-Based Approach
title_short Risk Factors, Temporal Dependence, and Seasonality of Human Extended-Spectrum β-Lactamases-Producing Escherichia coli and Klebsiella pneumoniae Colonization in Malawi: A Longitudinal Model-Based Approach
title_sort risk factors, temporal dependence, and seasonality of human extended-spectrum β-lactamases-producing escherichia coli and klebsiella pneumoniae colonization in malawi: a longitudinal model-based approach
topic Major Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10320086/
https://www.ncbi.nlm.nih.gov/pubmed/36869813
http://dx.doi.org/10.1093/cid/ciad117
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