Trends, relationships and case attribution of antibiotic resistance between children and environmental sources in rural India

Abstract

Bacterial antibiotic resistance is an important global health threat and the interfaces of antibiotic resistance between humans, animals and the environment are complex. We aimed to determine the associations and overtime trends of antibiotic resistance between humans, animals and water sources from the same area and time and estimate attribution of the other sources to cases of human antibiotic resistance. A total of 125 children (aged 1–3 years old) had stool samples analysed for antibiotic-resistant bacteria at seven time points over two years, with simultaneous collection of samples of animal stools and water sources in a rural Indian community. Newey–West regression models were used to calculate temporal associations, the source with the most statistically significant relationships was household drinking water. This is supported by use of SourceR attribution modelling, that estimated the mean attribution of cases of antibiotic resistance in the children from animals, household drinking water and wastewater, at each time point and location, to be 12.6% (95% CI 4.4–20.9%), 12.1% (CI 3.4–20.7%) and 10.3% (CI 3.2–17.3%) respectively. This underlines the importance of the ‘one health’ concept and requires further research. Also, most of the significant trends over time were negative, suggesting a possible generalised improvement locally.

Animal sources of antimicrobial-resistant bacterial infections in humans: a systematic review

“…Twenty-four studies were designed in the context of specific countries [ 22 – 44 ], and four were sub-national [ 45 – 48 ]. Most national and sub-national studies were conducted in North American and European countries, but three studies originated from SSEA countries [ 35 , 46 , 47 ]. The highest number (10) of national study publications were from the United States [ 11 , 25 – 29 , 32 , 38 , 39 , 42 ].…”

“…The articles were published over a range of nearly 40 years, mainly as a consequence of a 1984 investigation of resistant salmonellosis outbreaks in the United States [ 29 ]. However, most studies (87%) were published between 2012 and 2022, and 12 have been published since 2020 [ 19 , 21 , 22 , 25 , 30 , 34 , 35 , 38 – 40 , 46 , 47 ].…”

“…Based on the authors’ descriptions and reported methods, 16 articles were categorised as source attribution studies, including seven microbial subtyping studies [ 19 , 30 – 33 , 46 , 47 ], five investigations of outbreaks [ 25 – 29 ], three comparative exposure assessments [ 22 – 24 ], and one multi-directional dynamic risk model [ 34 ]. Twelve were classified as risk assessments [ 11 , 20 , 21 , 38 – 45 , 48 ], and the remaining three were of a different study type [ 35 – 37 ].…”

“…One article provided a framework for any high-or low-income country in South or South-East Asia (SSEA) [21]. Twenty-four studies were designed in the context of specific countries , and four were sub-national [45][46][47][48]. Most national and sub-national studies were conducted in North American and European countries, but three studies originated from SSEA countries [35,46,47].…”

Antimicrobial resistance in commensal Escherichia coli from humans and chickens in the Mekong Delta of Vietnam is driven by antimicrobial usage and potential cross-species transmission

“…Overuse and misuse of antimicrobials are important drivers of AMR, however, antimicrobial consumption alone does not explain the variations in AMR. 41 Therefore, other factors in the environment need considering from One Health perspectives such as the presence and AMU of co-existing animals, occupation, diet, health, sanitation, and cultural traditions. 42 A recent study showed that the association between AMU and AMR was more apparent for populations with higher hygiene levels.…”