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Colonisation dynamics of extended spectrum beta-lactamase-producing Enterobacterales in the gut of Malawian adults

Lewis, Joseph ORCID:, Mphasa, Madalitso, Banda, Rachel, Beale, Mathew A, Heinz, Eva ORCID:, Mallewa, Jane, Jewell, Christopher, Faragher, Brian, Thomson, Nicholas R and Feasey, Nicholas ORCID: (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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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):
Depositing User: Clare Bennett
Date Deposited: 07 Sep 2022 12:32
Last Modified: 19 Oct 2022 12:41


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