Investigating One Health risks for human colonisation with extended spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Malawian households: a longitudinal cohort study.


Cocker, Derek ORCID: 0000-0002-6670-2713, Chidziwisano, Kondwani, Mphasa, Madalitso, Mwapasa, Taonga, Lewis, Joseph M ORCID: 0000-0002-3837-5188, Rowlingson, Barry, Sammarro, Melodie, Bakali, Winnie, Salifu, Chifundo, Zuza, Allan et al (show 17 more authors) (2023) Investigating One Health risks for human colonisation with extended spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Malawian households: a longitudinal cohort study. The Lancet. Microbe, 4 (7). S2666-5247(23)00062-9-S2666-5247(23)00062-9.

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Abstract

<h4>Background</h4>Low-income countries have high morbidity and mortality from drug-resistant infections, especially from enteric bacteria such as Escherichia coli. In these settings, sanitation infrastructure is of variable and often inadequate quality, creating risks of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales transmission. We aimed to describe the prevalence, distribution, and risks of ESBL-producing Enterobacterales colonisation in sub-Saharan Africa using a One Health approach.<h4>Methods</h4>Between April 29, 2019, and Dec 3, 2020, we recruited 300 households in Malawi for this longitudinal cohort study: 100 each in urban, peri-urban, and rural settings. All households underwent a baseline visit and 195 were selected for longitudinal follow-up, comprising up to three additional visits over a 6 month period. Data on human health, antibiotic usage, health-seeking behaviours, structural and behavioural environmental health practices, and animal husbandry were captured alongside human, animal, and environmental samples. Microbiological processing determined the presence of ESBL-producing E coli and Klebsiella pneumoniae, and hierarchical logistic regression was performed to evaluate the risks of human ESBL-producing Enterobacterales colonisation.<h4>Findings</h4>A paucity of environmental health infrastructure and materials for safe sanitation was identified across all sites. A total of 11 975 samples were cultured, and ESBL-producing Enterobacterales were isolated from 1190 (41·8%) of 2845 samples of human stool, 290 (29·8%) of 973 samples of animal stool, 339 (66·2%) of 512 samples of river water, and 138 (46·0%) of 300 samples of drain water. Multivariable models illustrated that human ESBL-producing E coli colonisation was associated with the wet season (adjusted odds ratio 1·66, 95% credible interval 1·38-2·00), living in urban areas (2·01, 1·26-3·24), advanced age (1·14, 1·05-1·25), and living in households where animals were observed interacting with food (1·62, 1·17-2·28) or kept inside (1·58, 1·00-2·43). Human ESBL-producing K pneumoniae colonisation was associated with the wet season (2·12, 1·63-2·76).<h4>Interpretation</h4>There are extremely high levels of ESBL-producing Enterobacterales colonisation in humans and animals and extensive contamination of the wider environment in southern Malawi. Urbanisation and seasonality are key risks for ESBL-producing Enterobacterales colonisation, probably reflecting environmental drivers. Without adequate efforts to improve environmental health, ESBL-producing Enterobacterales transmission is likely to persist in this setting.<h4>Funding</h4>Medical Research Council, National Institute for Health and Care Research, and Wellcome Trust.<h4>Translation</h4>For the Chichewa translation of the abstract see Supplementary Materials section.

Item Type: Article
Uncontrolled Keywords: Animals, Humans, Escherichia coli, Klebsiella pneumoniae, Escherichia coli Infections, Klebsiella Infections, beta-Lactamases, Anti-Infective Agents, Cohort Studies, Longitudinal Studies, One Health
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User: Symplectic Admin
Date Deposited: 26 May 2023 09:28
Last Modified: 21 Jul 2023 06:45
DOI: 10.1016/s2666-5247(23)00062-9
Open Access URL: https://www.thelancet.com/journals/lanmic/article/...
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3170705
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