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CC BY V4.0, Open Access
Journal article
Identification of risk factors associated with carriage of resistant Escherichia coli in three culturally diverse ethnic groups in Tanzania: a biological and socioeconomic analysis
The Lancet. Planetary health, Vol.2(11), pp.e489-e497
11/2018
Handle:
https://hdl.handle.net/2376/117645
PMCID: PMC6215761
PMID: 30396440
Abstract
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.
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Details
- Title
- Identification of risk factors associated with carriage of resistant Escherichia coli in three culturally diverse ethnic groups in Tanzania: a biological and socioeconomic analysis
- Creators
- Mark A Caudell - Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, USA; Department of Anthropology, Washington State University, Pullman, WA, USAColette Mair - Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UKMurugan Subbiah - Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, USALouise Matthews - Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UKRobert J Quinlan - Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, USA; Department of Anthropology, Washington State University, Pullman, WA, USAMarsha B Quinlan - Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, USA; Department of Anthropology, Washington State University, Pullman, WA, USARuth Zadoks - Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UKJulius Keyyu - Tanzania Wildlife Research Institute, Arusha, TanzaniaDouglas R Call - Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, USA; Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania. Electronic address: drcall@wsu.edu
- Publication Details
- The Lancet. Planetary health, Vol.2(11), pp.e489-e497
- Academic Unit
- Anthropology, Department of; Paul G. Allen School for Global Animal Health
- Publisher
- Netherlands
- Grant note
- BB/L018926/1 / Biotechnology and Biological Sciences Research Council BB/K01126X/1 / Biotechnology and Biological Sciences Research Council MC_UU_12014/9 / Medical Research Council
- Identifiers
- 99900547842401842
- Language
- English
- Resource Type
- Journal article