Lewis, Joseph M 
ORCID: 0000-0002-3837-5188, Mphasa, Madalitso, Banda, Rachel, Beale, Mathew A, Heinz, Eva, Mallewa, Jane, Jewell, Christopher, Faragher, Brian, Thomson, Nicholas R and Feasey, Nicholas A
(2022)
Colonization dynamics of extended-spectrum beta-lactamase-producing Enterobacterales in the gut of Malawian adults.
NATURE MICROBIOLOGY, 7 (10).
1593-+.
Abstract
Drug-resistant bacteria of the order Enterobacterales which produce extended-spectrum beta-lactamase enzymes (ESBL-Enterobacterales, ESBL-E) are global priority pathogens. Antimicrobial stewardship interventions proposed to curb their spread include shorter courses of antimicrobials to reduce selection pressure but individual-level acquisition and selection dynamics are poorly understood. We sampled stool of 425 adults (aged 16-76 years) in Blantyre, Malawi, over 6 months and used multistate modelling and whole-genome sequencing to understand colonization dynamics of ESBL-E. Models suggest a prolonged effect of antimicrobials such that truncating an antimicrobial course at 2 days has a limited effect in reducing colonization. Genomic analysis shows largely indistinguishable diversity of healthcare-associated and community-acquired isolates, hence some apparent acquisition of ESBL-E during hospitalization may instead represent selection from a patient's microbiota by antimicrobial exposure. Our approach could help guide stewardship protocols; interventions that aim to review and truncate courses of unneeded antimicrobials may be of limited use in preventing ESBL-E colonization.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Intestines, Feces, Humans, Bacteria, Gammaproteobacteria, beta-Lactamases, Anti-Bacterial Agents, Adult |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 08 Sep 2022 14:29 |
| Last Modified: | 18 Jan 2023 20:45 |
| DOI: | 10.1038/s41564-022-01216-7 |
| Open Access URL: | https://doi.org/10.1038/s41564-022-01216-7 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3163882 |
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