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Risk factors, temporal dependence, and seasonality of human ESBL-producing E. coli and K. pneumoniae colonisation in Malawi: a longitudinal model-based approach

Sammarro, Melodie, Rowlingson, Barry, Cocker, Derek, Chidziwisano, Kondwani, Jacob, Shevin ORCID:, Kajumbula, Henry, Mugisha, Lawrence, Musoke, David, Lester, Rebecca ORCID:, Morse, Tracy, Feasey, Nicholas and Jewell, Chris (2023) 'Risk factors, temporal dependence, and seasonality of human ESBL-producing E. coli and K. pneumoniae colonisation in Malawi: a longitudinal model-based approach'. Clinical Infectious Diseases, Vol 77, Issue 1, pp. 1-8.

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Sub-Saharan Africa has the highest estimated death rate attributable to antimicrobial resistance (AMR), especially due to Extended-Spectrum Beta-Lactamase-producing Enterobacterales (ESBL-E). However, the dynamics of human colonisation in the community with ESBL-E are not well described. Inadequate water, sanitation and hygiene (WASH) infrastructure and associated behaviours are thought to play an important role in transmission of ESBL-E, and an improved understanding of the temporal dynamics of within-household transmission could help inform the design of future policies.

In this 18-month study, using microbiological data and household surveys, we built a multivariable hierarchical harmonic logistic regression model to identify risk factors for colonisation with ESBL-producing E. coli and K. pneumoniae, reflecting household structure and temporal correlation of colonisation status.

Being male was associated with a lower risk of colonisation with ESBL-producing E. coli (OR 0.786 CrI[0.678-0.910]) whilst the use of a tube well or a borehole was associated with an increased risk (OR 1.550 CrI[1.003-2.394]). For ESBL-producing K. pneumoniae, recent antibiotic exposure increased risk of colonisation (OR 1.281 CrI[1.049-1.565]) while sharing plates decreased that risk (OR 0.672 CrI[0.460-0.980]). Finally, the temporal correlation range of eight to eleven weeks provided evidence that within-household transmission occurs within this time frame.

We describe different risks for colonisation with different enteric bacterial species. Our findings suggest interventions to reduce transmission targeted at the household-level need to focus on improving WASH infrastructure and associated behaviours, whilst at the community level they should focus on both environmental hygiene and antibiotic stewardship.

Item Type: Article
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > WA 4 Works on general hygiene
WA Public Health > Water > WA 675 Water. Water supply. Sources
WA Public Health > Food > WA 695 Food. Food supply. Food inspection
WA Public Health > Housing. Buildings. Public Facilities > WA 795 Housing
WC Communicable Diseases > Infection. Bacterial Infections > Bacterial Infections > WC 202 Pneumonia (General or not elsewhere classified)
WC Communicable Diseases > Infection. Bacterial Infections > Enteric Infections > WC 290 Escherichia coli infections
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):
SWORD Depositor: JISC Pubrouter
Depositing User: JISC Pubrouter
Date Deposited: 13 Mar 2023 13:18
Last Modified: 11 Jul 2023 10:47


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