Gastrointestinal Carriage of Antimicrobial Resistance in School-Aged Children in Three Municipalities of Timor-Leste

Abstract

Invasive bacterial infections are a leading cause of death in children, primarily in low- and middle-income countries (LMIC). Links between carriage of antimicrobial-resistant organisms and more resistant infections have been established; however, little has been reported regarding community carriage of antibiotic-resistant organisms such as extended-spectrum β-lactamase (ESBL)-producing Enterobacterales in LMIC. The aim of this study was to determine colonic carriage of ESBL-producing fluoroquinolone- and aminoglycoside-resistant Enterobacterales in healthy children in three municipalities of Timor-Leste. In November 2020, 621 stool samples were collected from school-aged children and underwent screening for the presence of Enterobacterales species and antimicrobial resistance (AMR). Ciprofloxacin-resistant Gram-negative organisms were cultured from 16.5% (95% CI 6.2–26.9), and gentamicin resistance was identified in 6.8% (95% CI 2.8–10.7). Compared to the prevalence of ciprofloxacin resistance in Dili (36.1%), there was significantly lower prevalence in the rural municipalities of Ermera (12.9%; AOR 0.38, 95% CI 0.24–0.60, p < 0.001) and Manufahi (4.5%; AOR 0.07, 95% CI 0.01–0.51, p = 0.009). The overall cluster-adjusted prevalence of ESBL-producing bacteria was 8.3%, with no significant differences between municipalities. This study demonstrates high rates of carriage of AMR among school-aged children in Timor-Leste, with higher rates observed in Dili compared to rural municipalities. Empiric antibiotic guidelines should include recommendations for treating community-acquired infections that account for the possibility of antimicrobial resistance.

Prevalence of Antimicrobial Resistance in Escherichia coli and Salmonella Species Isolates from Chickens in Live Bird Markets and Boot Swabs from Layer Farms in Timor-Leste

“…Resistance to gentamicin and ciprofloxacin in E. coli isolates based on broth-based microdilution from this study was lower than that reported in E. coli isolates from the stools of healthy school children from Timor-Leste [29], although a direct comparison cannot be made because the screening of E. coli isolates in the latter study involved the use of selective ESBL agar [29]. No E. coli or Salmonella spp.…”

“…resistance to antimicrobials listed in the Timor-Leste Antimicrobial Guidelines for human health [41] were generally below 25%, except for resistance to temocillin and ciprofloxacin in Salmonella spp. It is unlikely that the high rates of AMR carriage in humans in Timor-Leste [28,29] is driven by transmission from household chickens.…”

“…In Timor-Leste, there have been some studies on AMR in humans that have shown relatively high rates of carriage of resistant bacteria in humans exhibiting resistance to critically important antimicrobials such as ceftriaxone, ciprofloxacin and gentamicin [28,29]. However, there are no published studies investigating the role of animals in the transmission of antimicrobial resistant bacteria and its potential public health implications.…”

Is an active hospital microbiology laboratory cost-effective in a resource-limited setting? - a case study from Timor-Leste

“…Previous studies have indicated a high rate of AMR in Timor-Leste. [5][6][7] A previous analysis of surveillance by blood culture in low to middle income countries in Africa to inform empirical antibiotic therapy policy in sepsis concluded that this intervention was cost-effective for this purpose, but did not consider whether routine use of blood cultures for microbiologically-informed targeted antibiotic treatment in the patients tested was also economically rational. 8 The aim of the current study was to determine if, in Timor-Leste, a low-middle income country, blood culture and sensitivity testing to guide antibiotic therapy for the individual patient with sepsis at the HNGV tertiary referral hospital is cost-effective.…”

Editorial for the Special Issue “Antibiotic Prescribing and Antimicrobial Resistance Patterns in Pediatric Patients”

“…Finally, Oakley et al conducted a cross-sectional survey among school-aged children of Timor-Leste to investigate community carriage of AMR pathogens, including extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales [ 13 ]. Among the 621 investigated stool samples, the prevalence of ESBL-producing bacteria was over 8%, suggesting high rates of carriage of AMR pathogens in the community, which is an important implication for empiric therapy recommendations.…”