Antimicrobial Resistance in Humans, Animals, Water and Household Environs in Rural Andean Peru: Exploring Dissemination Pathways through the One Health Lens
Abstract
:1. Introduction
2. Methods
2.1. Study Site
2.2. Study Design
2.2.1. Sample Collection
Human and Animal Fecal Samples
Environmental Samples
2.2.2. Laboratory Analysis of Samples
Antibiotic Susceptibility Testing
Extended Spectrum Beta Lactamases (ESBL) Detection and Confirmation
2.2.3. Questionnaires
2.3. Data Analysis
2.4. Ethics
3. Results
3.1. AMR Dissemination Pathways in Rural Settings
3.2. Setting Description
3.3. Water Samples
3.4. Soil Samples
3.5. Child Fecal Samples
3.6. Animal Fecal Samples
3.7. Multidrug Resistance Profiles
3.8. Detection of ESBL Resistance Genes
4. Discussion
5. Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
AMR | Antimicrobial resistance |
LMIC | Low- and middle-income countries |
CFU | colonies forming units |
CLSI | Clinical and Laboratory Standards Institute |
JASS | community water supply and irrigation committee |
HWT | Household water treatment |
MDR | Multidrug-resistant |
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N | Mean [SD] or % (N) | |
---|---|---|
Demographic characteristics | 40 | |
Number of inhabitants per household | 5.0 [1.44] | |
Number of children under 6 per household | 1.4 [0.53] | |
Household characteristics | ||
Adobe wall type | ||
- Coated adobe or rammed earth | 60 (24) | |
- Uncoated adobe or rammed earth | 22.5 (9) | |
Latrines w/o ventilation | ||
- Septic tank | 22.5 (9) | |
- Latrine | 75 (30) | |
Piped water supply | ||
- Public water supply system/piped water in the house | 72.5 (29) | |
- Public water supply system/piped water outside the house | 20 (8) | |
- Public water supply system/piped water outside the house but inside the building | 2.5 (1) | |
- Surface water, spring | 5 (2) | |
Energy source | ||
- Electricity | 87.5 (35) | |
- Candle | 5 (2) | |
- Solar Panel | 7.5 (3) | |
Household Water Treatment | ||
Boiling | 60 (24) | |
Chlorine or bleach | 12.5 (5) | |
None | 27.5 (11) | |
Animal Management and treatment | ||
The last time the animal was treated; did the animal receive any antibiotic? | 72.5 (29) | |
Antibiotic used for the treatment | ||
- Amoxicillin | 3.1 (1) | |
- “Biomizona“ 1 | 21.8 (7) | |
- “Ciclosona” 2 | 50 (16) | |
- “Emicina” 3 | 3.1 (1) | |
- “Hipradoxi S” 4 | 3.1 (1) | |
- “Hipralona” 5 | 6.2 (2) | |
- “Quinolaba” 5 | 6.2 (2) | |
- “Tylogen” 6 | 6.2 (2) | |
Where did they get the antibiotic? | ||
- Directly form a veterinarian | 18.7 (6) | |
- Directly from a veterinarian technician | 50 (16) | |
- From a neighbour or relative | 3.1 (1) | |
- At a local veterinary store | 18.7 (6) | |
- At a veterinary store in the area | 0 | |
- At a pharmacy | 0 | |
- Other place | 9.3 (3) |
Coliforms (Count) | Water from Reservoir (N = 26) % (N) | Main Household’s Water (N = 40) % (N) | Child’s Drinking Water (N = 40) % (N) |
---|---|---|---|
Thermotolerant coliform count (IQR 1st–3rd Quantile) | 0–3.75 | 0–10.5 | 0–9.5 |
Thermotolerant coliform (CFU/mL)—mean (SD) | 14.3 (59.2) | 36.2 (108.4) | 104.1 (373.5) |
Total positive thermotolerant sample | 34.6 (9) | 45 (18) | 32.5 (13) |
Total thermotolerant bacterial isolates * | N = 14 % (n) | N = 28 % (n) | N = 27 % (n) |
Total positive Enterobacteriaceae isolates | 92.8 (13) | 82.1 (23) | 74.0 (20) |
E. coli | 92.8 (13) | 57.1 (16) | 44.4 (12) |
Klebsiella spp. | 0 | 10.7 (3) | 14.8 (4) |
Enterobacter spp. | 0 | 14.8 (4) | 14.2 (4) |
Water from Reservoir | Main Household’s Water | Child’s Drinking Water | |||
---|---|---|---|---|---|
E. coli N = 13 | E. coli N = 16 | Klebsiella spp. N = 3 | E. coli N = 12 | Klebsiella spp. N = 4 | |
Antibiotic | Resistance % (N) | Resistance % (N) | Resistance % (N) | ||
Amoxicillin-clavulanic acid | 0 | 0 | 0 | 0 | 0 |
Ampicillin | 0 | 18.8 (3) | 100 (3) | 25 (3) | 100 (4) |
Aztreonam | 0 | 0 | 0 | 0 | 0 |
Cefotaxime | 15.4 (2) | 0 | 0 | 8.3 (1) | 0 |
Cefoxitin | 0 | 0 | 0 | 0 | 0 |
Chloramphenicol | 7.7 (1) | 12.5 (2) | 0 | 25 (3) | 0 |
Ciprofloxacin | 0 | 6.3 (1) | 33.3 (1) | 16.7 (2) | 25 (1) |
Gentamicin | 0 | 6.3 (1) | 0 | 8.3 (1) | 0 |
Nalidixic acid | 0 | 18.8 (3) | 0 | 16.7 (2) | 0 |
Trimethoprim-sulfamethoxazole | 0 | 0 | 33.3 (1) | 8.3 (1) | 25 (1) |
Tetracycline | 15.4 (2) | 31.3 (5) | 33.3 (1) | 41.7 (5) | 25 (1) |
Ceftriazone | 0 | 0 | 0 | 11.1 (1) | 0 |
Cefepime | 0 | 0 | 0 | 8.3 (1) | 0 |
Imipenem | 0 | 0 | 0 | 0 | 0 |
AMR to at least one antibiotic 1 | 30.8(4) | 43.8 (3) | 100 (3) | 41.7 (5) | 100 (4) |
Multidrug resistance 2 | 0 (0) | 18.6 (3) | 33.3 (1) | 33.3 (4) | 25 (1) |
Coliforms | Soil (N = 40) % (n) | Child Faeces (N = 40) % (n) | Animal Faeces (N = 80) % (n) |
---|---|---|---|
Thermotolerant coliforms | 100 (40) | 97.5 (39) | 67.5 (54) |
Total thermotolerant bacterial isolates | N = 83 % (n) | N = 98 % (n) | N = 116 % (n) |
E. coli | 43.3 (36) | 45.3 (44) | 38.7 (45) |
Klebsiella spp. | 4.8 (4) | 11.3 (11) | 5.1 (6) |
Enterobacter spp. | 24.1 (20) | 6.2 (6) | 4.3 (5) |
Citrobacter spp. | 9.6 (8) | 9.2 (9) | 16.3 (19) |
Soil | Child Faeces | Animal Faeces | ||||
---|---|---|---|---|---|---|
E. coli N = 36 | Klebsiella spp. N = 4 | E. coli N = 44 | Klebsiella spp. N = 11 | E. coli N = 45 | Klebsiella spp. N = 6 | |
Antibiotic | Resistance % (N) | Resistance % (N) | Resistance % (N) | |||
Amoxicillin-clavulanic acid | 0 | 25 (1) | 0 | 9.1 (1) | 4.4 (2) | 0 |
Ampicillin | 11.1 (4) | 75 (3) | 34.1 (15) | 54.5 (6) | 11.1 (5) | 50 (3) |
Aztreonam | 0 | 0 | 2.3 (1) | 0 | 2.2 (1) | 0 |
Cefotaxime | 0 | 0 | 0 | 0 | 0 | 0 |
Cefoxitin | 2.8 (1) | 25 (1) | 0 | 9.1 (1) | 4.4 (2) | 0 |
Chloramphenicol | 2.8 (1) | 0 | 4.5 (2) | 0 | 11.1 (5) | 0 |
Ciprofloxacin | 5.5 (2) | 0 | 11.4 (5) | 0 | 8.8 (4) | 0 |
Gentamicin | 0 | 0 | 2.3 (1) | 0 | 0 | 0 |
Nalidixic acid | 5.5 (2) | 0 | 13.6 (6) | 0 | 20 (9) | 0 |
Trimethoprim-sulfamethoxazole | 5.5 (2) | 0 | 20.5 (9) | 9.1 (1) | 11.1 (5) | 0 |
Tetracycline | 25.0 (9) | 0 | 25.0 (11) | 9.1 (1) | 26.6 (12) | 0 |
Ceftriazone | 0 | 0 | 2.3 (1) | 0 | 0 | 0 |
Cefepime | 0 | 0 | 0 | 0 | 0 | 0 |
Imipenem | 0 | 0 | 0 | 0 | 0 | 0 |
AMR1 | 33.3 (12) | 75 (3) | 52.3 (23) | 54.6 (6) | 37.7 (17) | 50 (3) |
MDR2 | 2.8 (1) | 0 (0) | 15.9 (7) | 0 (0) | 0 (0) | 0 (0) |
Source Type *** | MDR | Antimicrobial Class ** |
---|---|---|
Child Water | AMP, TE y C | Penicillin |
Child Water | SXT, TE, C | Sulfonamides, tetracycline, quinolone |
Child Water | NA, CIP y TE | Quinolone, tetracycline |
Child Water * | AMP, CTX, CRO, FEP, NA, CIP, TE, C y CN | Penicillin, 3rd & 4th generation cephalosporin, quinolone, tetracycline |
HH Water Source | NA, TE, C y CN | Quinolone, tetracycline |
HH Water Source | NA, CIP, SXT, TE, C | Quinolone, sulfonamides, tetracycline |
HH Water Source | AMP, SXT, TE | Penicillin, quinolone, tetracycline |
Soil | AMP, NA, CIP, SXT, TE, C | Penicillin, quinolone, sulfonamides, tetracycline |
Child faeces | AMP, NA, CIP, SXT, TE y CN | Penicillin, quinolone, sulfonamides, tetracycline |
Child faeces | AMP, SXT, TE | Penicillin, sulfonamides, tetracycline |
Child faeces | AMP, TE, C | Penicillin, tetracycline, quinolone |
Child faeces | AMP, SXT, TE | Penicillin, sulfonamides, tetracycline |
Child faeces | CRO, CIP, SXT | 3rd generation cephalosporin, quinolone, sulfonamides |
Child faeces | AMP, SXT, TE | Penicillin, sulfonamides |
Child faeces | AMP, NA, CIP, SXT, TE | Penicillin, quinolone, sulfonamides, tetracycline |
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Hartinger, S.M.; Medina-Pizzali, M.L.; Salmon-Mulanovich, G.; Larson, A.J.; Pinedo-Bardales, M.; Verastegui, H.; Riberos, M.; Mäusezahl, D. Antimicrobial Resistance in Humans, Animals, Water and Household Environs in Rural Andean Peru: Exploring Dissemination Pathways through the One Health Lens. Int. J. Environ. Res. Public Health 2021, 18, 4604. https://doi.org/10.3390/ijerph18094604
Hartinger SM, Medina-Pizzali ML, Salmon-Mulanovich G, Larson AJ, Pinedo-Bardales M, Verastegui H, Riberos M, Mäusezahl D. Antimicrobial Resistance in Humans, Animals, Water and Household Environs in Rural Andean Peru: Exploring Dissemination Pathways through the One Health Lens. International Journal of Environmental Research and Public Health. 2021; 18(9):4604. https://doi.org/10.3390/ijerph18094604
Chicago/Turabian StyleHartinger, Stella M., Maria Luisa Medina-Pizzali, Gabriela Salmon-Mulanovich, Anika J. Larson, María Pinedo-Bardales, Hector Verastegui, Maribel Riberos, and Daniel Mäusezahl. 2021. "Antimicrobial Resistance in Humans, Animals, Water and Household Environs in Rural Andean Peru: Exploring Dissemination Pathways through the One Health Lens" International Journal of Environmental Research and Public Health 18, no. 9: 4604. https://doi.org/10.3390/ijerph18094604