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 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.

Informations de copyright

© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

Déclaration de conflit d'intérêts

Potential conflicts of interest. N. F. reports grants or contracts for Environmental Surveillance for Vaccine Impact Assessment (BMGF 2022-2025), for Global Health Professorship from NIHR (NIHR 2022-2027), for NeoTrack from BMGF (BMGF 2021-2023), from UKRI as the co-investigator for Strength in Places (UKRI 202-2025), and for Chatinkha Seq from BMGF (BMGF 2020-2022); participation in a Data Safety Monitoring or Advisory Board for a Phase 2 trial to assess the safety and immunogenicity of Trivalent Salmonella Conjugate Vaccine with the Centre for Vaccine Development, University of Maryland; roles as Chair of Wellcome's Surveillance and Epidemiology of Drug Resistant Infections and Chair of UK Department of Health and Social Care's Fleming Fund Technical Advisory Group. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.