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Lewis, Joseph 
ORCID: https://orcid.org/0000-0002-3837-5188, Mphasa, Madalitso, Banda, Rachel, Beale, Mathew A, Heinz, Eva ORCID: https://orcid.org/0000-0003-4413-3756, Mallewa, Jane, Jewell, Christopher, Faragher, Brian, Thomson, Nicholas R and Feasey, Nicholas ORCID: https://orcid.org/0000-0003-4041-1405
(2022)
'Colonisation dynamics of extended spectrum beta-lactamase-producing Enterobacterales in the gut of Malawian adults'. Nature Microbiology, Vol 7, Issue 10, pp. 1593-1604.
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Nature_Micro_s41564-022-01216-7.pdf - Published Version Available under License Creative Commons Attribution. Download (7MB) | Preview |
Abstract
Drug-resistant bacteria of the order Enterobacterales which produce extended-spectrum beta-lactamase enzymes (ESBL-Enterobacterales: ESBL-E) are global priority pathogens. Antimicrobial stewardship interventions proposed to curb their spread include shorter courses of antimicrobials to reduce selection pressure, but individual-level acquisition and selection dynamics are poorly understood. We sampled stool of 425 adults (aged 16-76) in Blantyre, Malawi, over six months and used multi-state modelling and whole-genome sequencing to understand colonisation dynamics of ESBL-E. Models suggest a prolonged effect of antimicrobials such that truncating an antimicrobial course at two days has a limited effect in reducing colonisation. Genomic analysis shows largely indistinguishable diversity of healthcare-associated and community-acquired isolates, hence some apparent acquisition of ESBL-E during hospitalisation may instead represent selection from a patient’s microbiota by antimicrobial exposure. Our approach could help guide stewardship protocols; interventions that aim to review and truncate courses of unneeded antimicrobials may be of limited use in preventing ESBL-E colonisation.
| Item Type: | Article |
|---|---|
| Subjects: | QU Biochemistry > Genetics > QU 460 Genomics. Proteomics QU Biochemistry > Genetics > QU 550 Genetic techniques. PCR. Chromosome mapping QW Microbiology and Immunology > Bacteria > QW 138 Enterobacteriaceae QW Microbiology and Immunology > QW 45 Microbial drug resistance. General or not elsewhere classified. |
| Faculty: Department: | Biological Sciences > Vector Biology Department Clinical Sciences & International Health > Clinical Sciences Department |
| Digital Object Identifer (DOI): | https://doi.org/10.1038/s41564-022-01216-7 |
| Depositing User: | Clare Bennett |
| Date Deposited: | 07 Sep 2022 12:32 |
| Last Modified: | 19 Oct 2022 12:41 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/20873 |
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