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Investigating One Health risks for human colonisation with extended spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Malawian households: a longitudinal cohort study

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Investigating One Health risks for human colonisation with extended spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Malawian households: a longitudinal cohort study. / Cocker, Derek; Chidziwisano, Kondwani; Mphasa, Madalitso et al.
In: The Lancet. Microbe, Vol. 4, No. 7, 31.07.2023, p. e534-e543.

Research output: Contribution to Journal/Magazine › Journal article › peer-review

Harvard

Cocker, D, Chidziwisano, K, Mphasa, M, Mwapasa, T, Lewis, JM, Rowlingson, B, Sammarro, M, Bakali, W, Salifu, C, Zuza, A, Charles, M, Mandula, T, Maiden, V, Amos, S, Jacob, ST, Kajumbula, H, Mugisha, L, Musoke, D, Byrne, R, Edwards, T, Lester, R, Elviss, N, Roberts, AP, Singer, AC, Jewell, C, Morse, T & Feasey, NA 2023, 'Investigating One Health risks for human colonisation with extended spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Malawian households: a longitudinal cohort study', The Lancet. Microbe, vol. 4, no. 7, pp. e534-e543. https://doi.org/10.1016/S2666-5247(23)00062-9

APA

Cocker, D., Chidziwisano, K., Mphasa, M., Mwapasa, T., Lewis, J. M., Rowlingson, B., Sammarro, M., Bakali, W., Salifu, C., Zuza, A., Charles, M., Mandula, T., Maiden, V., Amos, S., Jacob, S. T., Kajumbula, H., Mugisha, L., Musoke, D., Byrne, R., ... Feasey, N. A. (2023). Investigating One Health risks for human colonisation with extended spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Malawian households: a longitudinal cohort study. The Lancet. Microbe, 4(7), e534-e543. https://doi.org/10.1016/S2666-5247(23)00062-9

Vancouver

Cocker D, Chidziwisano K, Mphasa M, Mwapasa T, Lewis JM, Rowlingson B et al. Investigating One Health risks for human colonisation with extended spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Malawian households: a longitudinal cohort study. The Lancet. Microbe. 2023 Jul 31;4(7):e534-e543. Epub 2023 May 16. doi: 10.1016/S2666-5247(23)00062-9

Author

Cocker, Derek ; Chidziwisano, Kondwani ; Mphasa, Madalitso et al. / Investigating One Health risks for human colonisation with extended spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Malawian households : a longitudinal cohort study. In: The Lancet. Microbe. 2023 ; Vol. 4, No. 7. pp. e534-e543.

Bibtex

@article{17db2d0543e64feb95cb3dfc708d26e3,
title = "Investigating One Health risks for human colonisation with extended spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Malawian households: a longitudinal cohort study",
abstract = "BACKGROUND: Low-income countries have high morbidity and mortality from drug-resistant infections, especially from enteric bacteria such as Escherichia coli. In these settings, sanitation infrastructure is of variable and often inadequate quality, creating risks of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales transmission. We aimed to describe the prevalence, distribution, and risks of ESBL-producing Enterobacterales colonisation in sub-Saharan Africa using a One Health approach.METHODS: Between April 29, 2019, and Dec 3, 2020, we recruited 300 households in Malawi for this longitudinal cohort study: 100 each in urban, peri-urban, and rural settings. All households underwent a baseline visit and 195 were selected for longitudinal follow-up, comprising up to three additional visits over a 6 month period. Data on human health, antibiotic usage, health-seeking behaviours, structural and behavioural environmental health practices, and animal husbandry were captured alongside human, animal, and environmental samples. Microbiological processing determined the presence of ESBL-producing E coli and Klebsiella pneumoniae, and hierarchical logistic regression was performed to evaluate the risks of human ESBL-producing Enterobacterales colonisation.FINDINGS: A paucity of environmental health infrastructure and materials for safe sanitation was identified across all sites. A total of 11 975 samples were cultured, and ESBL-producing Enterobacterales were isolated from 1190 (41·8%) of 2845 samples of human stool, 290 (29·8%) of 973 samples of animal stool, 339 (66·2%) of 512 samples of river water, and 138 (46·0%) of 300 samples of drain water. Multivariable models illustrated that human ESBL-producing E coli colonisation was associated with the wet season (adjusted odds ratio 1·66, 95% credible interval 1·38-2·00), living in urban areas (2·01, 1·26-3·24), advanced age (1·14, 1·05-1·25), and living in households where animals were observed interacting with food (1·62, 1·17-2·28) or kept inside (1·58, 1·00-2·43). Human ESBL-producing K pneumoniae colonisation was associated with the wet season (2·12, 1·63-2·76).INTERPRETATION: There are extremely high levels of ESBL-producing Enterobacterales colonisation in humans and animals and extensive contamination of the wider environment in southern Malawi. Urbanisation and seasonality are key risks for ESBL-producing Enterobacterales colonisation, probably reflecting environmental drivers. Without adequate efforts to improve environmental health, ESBL-producing Enterobacterales transmission is likely to persist in this setting.FUNDING: Medical Research Council, National Institute for Health and Care Research, and Wellcome Trust.TRANSLATION: For the Chichewa translation of the abstract see Supplementary Materials section.",
author = "Derek Cocker and Kondwani Chidziwisano and Madalitso Mphasa and Taonga Mwapasa and Lewis, {Joseph M} and Barry Rowlingson and Melodie Sammarro and Winnie Bakali and Chifundo Salifu and Allan Zuza and Mary Charles and Tamandani Mandula and Victor Maiden and Stevie Amos and Jacob, {Shevin T} and Henry Kajumbula and Lawrence Mugisha and David Musoke and Rachel Byrne and Thomas Edwards and Rebecca Lester and Nicola Elviss and Roberts, {Adam P} and Singer, {Andrew C} and Christopher Jewell and Tracy Morse and Feasey, {Nicholas A}",
year = "2023",
month = jul,
day = "31",
doi = "10.1016/S2666-5247(23)00062-9",
language = "English",
volume = "4",
pages = "e534--e543",
journal = "The Lancet. Microbe",
issn = "2666-5247",
publisher = "Elsevier Ltd",
number = "7",

}

RIS

TY - JOUR

T1 - Investigating One Health risks for human colonisation with extended spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Malawian households

T2 - a longitudinal cohort study

AU - Cocker, Derek

AU - Chidziwisano, Kondwani

AU - Mphasa, Madalitso

AU - Mwapasa, Taonga

AU - Lewis, Joseph M

AU - Rowlingson, Barry

AU - Sammarro, Melodie

AU - Bakali, Winnie

AU - Salifu, Chifundo

AU - Zuza, Allan

AU - Charles, Mary

AU - Mandula, Tamandani

AU - Maiden, Victor

AU - Amos, Stevie

AU - Jacob, Shevin T

AU - Kajumbula, Henry

AU - Mugisha, Lawrence

AU - Musoke, David

AU - Byrne, Rachel

AU - Edwards, Thomas

AU - Lester, Rebecca

AU - Elviss, Nicola

AU - Roberts, Adam P

AU - Singer, Andrew C

AU - Jewell, Christopher

AU - Morse, Tracy

AU - Feasey, Nicholas A

PY - 2023/7/31

Y1 - 2023/7/31

N2 - BACKGROUND: Low-income countries have high morbidity and mortality from drug-resistant infections, especially from enteric bacteria such as Escherichia coli. In these settings, sanitation infrastructure is of variable and often inadequate quality, creating risks of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales transmission. We aimed to describe the prevalence, distribution, and risks of ESBL-producing Enterobacterales colonisation in sub-Saharan Africa using a One Health approach.METHODS: Between April 29, 2019, and Dec 3, 2020, we recruited 300 households in Malawi for this longitudinal cohort study: 100 each in urban, peri-urban, and rural settings. All households underwent a baseline visit and 195 were selected for longitudinal follow-up, comprising up to three additional visits over a 6 month period. Data on human health, antibiotic usage, health-seeking behaviours, structural and behavioural environmental health practices, and animal husbandry were captured alongside human, animal, and environmental samples. Microbiological processing determined the presence of ESBL-producing E coli and Klebsiella pneumoniae, and hierarchical logistic regression was performed to evaluate the risks of human ESBL-producing Enterobacterales colonisation.FINDINGS: A paucity of environmental health infrastructure and materials for safe sanitation was identified across all sites. A total of 11 975 samples were cultured, and ESBL-producing Enterobacterales were isolated from 1190 (41·8%) of 2845 samples of human stool, 290 (29·8%) of 973 samples of animal stool, 339 (66·2%) of 512 samples of river water, and 138 (46·0%) of 300 samples of drain water. Multivariable models illustrated that human ESBL-producing E coli colonisation was associated with the wet season (adjusted odds ratio 1·66, 95% credible interval 1·38-2·00), living in urban areas (2·01, 1·26-3·24), advanced age (1·14, 1·05-1·25), and living in households where animals were observed interacting with food (1·62, 1·17-2·28) or kept inside (1·58, 1·00-2·43). Human ESBL-producing K pneumoniae colonisation was associated with the wet season (2·12, 1·63-2·76).INTERPRETATION: There are extremely high levels of ESBL-producing Enterobacterales colonisation in humans and animals and extensive contamination of the wider environment in southern Malawi. Urbanisation and seasonality are key risks for ESBL-producing Enterobacterales colonisation, probably reflecting environmental drivers. Without adequate efforts to improve environmental health, ESBL-producing Enterobacterales transmission is likely to persist in this setting.FUNDING: Medical Research Council, National Institute for Health and Care Research, and Wellcome Trust.TRANSLATION: For the Chichewa translation of the abstract see Supplementary Materials section.

AB - BACKGROUND: Low-income countries have high morbidity and mortality from drug-resistant infections, especially from enteric bacteria such as Escherichia coli. In these settings, sanitation infrastructure is of variable and often inadequate quality, creating risks of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales transmission. We aimed to describe the prevalence, distribution, and risks of ESBL-producing Enterobacterales colonisation in sub-Saharan Africa using a One Health approach.METHODS: Between April 29, 2019, and Dec 3, 2020, we recruited 300 households in Malawi for this longitudinal cohort study: 100 each in urban, peri-urban, and rural settings. All households underwent a baseline visit and 195 were selected for longitudinal follow-up, comprising up to three additional visits over a 6 month period. Data on human health, antibiotic usage, health-seeking behaviours, structural and behavioural environmental health practices, and animal husbandry were captured alongside human, animal, and environmental samples. Microbiological processing determined the presence of ESBL-producing E coli and Klebsiella pneumoniae, and hierarchical logistic regression was performed to evaluate the risks of human ESBL-producing Enterobacterales colonisation.FINDINGS: A paucity of environmental health infrastructure and materials for safe sanitation was identified across all sites. A total of 11 975 samples were cultured, and ESBL-producing Enterobacterales were isolated from 1190 (41·8%) of 2845 samples of human stool, 290 (29·8%) of 973 samples of animal stool, 339 (66·2%) of 512 samples of river water, and 138 (46·0%) of 300 samples of drain water. Multivariable models illustrated that human ESBL-producing E coli colonisation was associated with the wet season (adjusted odds ratio 1·66, 95% credible interval 1·38-2·00), living in urban areas (2·01, 1·26-3·24), advanced age (1·14, 1·05-1·25), and living in households where animals were observed interacting with food (1·62, 1·17-2·28) or kept inside (1·58, 1·00-2·43). Human ESBL-producing K pneumoniae colonisation was associated with the wet season (2·12, 1·63-2·76).INTERPRETATION: There are extremely high levels of ESBL-producing Enterobacterales colonisation in humans and animals and extensive contamination of the wider environment in southern Malawi. Urbanisation and seasonality are key risks for ESBL-producing Enterobacterales colonisation, probably reflecting environmental drivers. Without adequate efforts to improve environmental health, ESBL-producing Enterobacterales transmission is likely to persist in this setting.FUNDING: Medical Research Council, National Institute for Health and Care Research, and Wellcome Trust.TRANSLATION: For the Chichewa translation of the abstract see Supplementary Materials section.

U2 - 10.1016/S2666-5247(23)00062-9

DO - 10.1016/S2666-5247(23)00062-9

M3 - Journal article

C2 - 37207684

VL - 4

SP - e534-e543

JO - The Lancet. Microbe

JF - The Lancet. Microbe

SN - 2666-5247

IS - 7

ER -