Human Colonization With Multidrug-Resistant Organisms: Getting to the Bottom of Antibiotic Resistance

Smith, Rachel M.; Lautenbach, Ebbing; Omulo, Sylvia; Araos, Rafael; Call, Douglas R.; Kumar, Girish; Chowdhury, Fahmida; McDonald, Clifford; Park, Benjamin J.

doi:10.1093/ofid/ofab531

Cited by 16 publications

(14 citation statements)

References 12 publications

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“…AMR surveillance that relies on clinically diagnosed infections may not fully describe the true burden of AMR because these systems have the potential to be heavily affected by health-seeking behavior and availability and affordability of diagnostics [ 9 ]. Assessing the prevalence of resistant organisms through colonization screening can help inform surveillance efforts.…”

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confidence: 99%

“…Although persons colonized with antibiotic-resistant organisms do not manifest any symptoms related to colonization, they are more likely to develop future resistant infections and can transmit resistant pathogens to other individuals [ 12 ]. Identifying rates of colonization with ESBL-producing Enterobacterales, CRE, colistin-resistant Enterobacterales (ColRE), and MRSA in hospitals and communities provides a useful opportunity to detect emergence and spread of antibiotic-resistant bacteria ahead of trends in clinical infections and provides a more holistic description of the burden of AMR in a geographic area [ 9 , 13 ].…”

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confidence: 99%

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Prevalence of Colonization With Antibiotic-Resistant Organisms in Hospitalized and Community Individuals in Bangladesh, a Phenotypic Analysis: Findings From the Antibiotic Resistance in Communities and Hospitals (ARCH) Study

Chowdhury

Mah‐E‐Muneer

Bollinger

et al. 2023

Clinical Infectious Diseases

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Background Low- and middle-income countries bear a disproportionate burden of antimicrobial resistance (AMR) but often lack adequate surveillance to inform mitigation efforts. Colonization can be a useful metric to understand AMR burden. We assessed the colonization prevalence of Enterobacterales with resistance to extended-spectrum cephalosporins, carbapenems, colistin, and methicillin-resistant Staphylococcus aureus among hospital and community dwellers. Methods Between April and October 2019, we conducted a period prevalence study in Dhaka, Bangladesh. We collected stool and nasal specimens from adults in 3 hospitals and from community dwellers within the hospitals’ catchment area. Specimens were plated on selective agar plates. Isolates underwent identification and antibiotic susceptibility testing using Vitek 2. We performed descriptive analysis and determined population prevalence estimates accounting for clustering at the community level. Results The majority of both community and hospital participants were colonized with Enterobacterales with resistance to extended-spectrum cephalosporins (78%; 95% confidence interval [95% CI], 73–83; and 82%; 95% CI, 79–85, respectively). Thirty-seven percent (95% CI, 34–41) of hospitalized patients were colonized with carbapenems compared with 9% (95% CI, 6–13) of community individuals. Colistin colonization prevalence was 11% (95% CI, 8–14) in the community versus 7% (95% CI, 6–10) in the hospital. Methicillin-resistant Staphylococcus aureus colonization was similar in both community and hospital participants (22%; 95% CI, 19–26 vs 21% (95% CI, 18–24). Conclusions The high burden of AMR colonization observed among hospital and community participants may increase the risk for developing AMR infections and facilitating spread of AMR in both the community and hospital.

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confidence: 99%

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confidence: 99%

Prevalence of Colonization With Antibiotic-Resistant Organisms in Hospitalized and Community Individuals in Bangladesh, a Phenotypic Analysis: Findings From the Antibiotic Resistance in Communities and Hospitals (ARCH) Study

Chowdhury

Mah‐E‐Muneer

Bollinger

et al. 2023

Clinical Infectious Diseases

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“…Current initiatives that seek to build AMR surveillance capacity, such as the World Health Organization's Global Antimicrobial Resistance and Use Surveillance System, focus on capturing incident clinical infections [ 7 ]. Although such an approach has long been the standard, it depends on substantial healthcare utilization and diagnostic stewardship capacities that are only sometimes available in low- and middle-income countries, which can introduce substantial ascertainment bias into surveillance data, resulting in inaccurate estimates [ 8 , 9 ]. Additionally, effective surveillance of AR-GNB to support public health action needs to go beyond clinical isolates identified in healthcare settings and include assessments of the burden of AMR in communities.…”

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confidence: 99%

High Burden of Intestinal Colonization With Antimicrobial-Resistant Bacteria in Chile: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study

Araos,

Smith,

Styczynski

et al. 2023

Clinical Infectious Diseases

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Background Antimicrobial resistance is a global threat, heavily impacting low- and middle-income countries. This study estimated antimicrobial-resistant gram-negative bacteria (GNB) fecal colonization prevalence in hospitalized and community-dwelling adults in Chile before the coronavirus disease 2019 pandemic. Methods From December 2018 to May 2019, we enrolled hospitalized adults in 4 public hospitals and community dwellers from central Chile, who provided fecal specimens and epidemiological information. Samples were plated onto MacConkey agar with ciprofloxacin or ceftazidime added. All recovered morphotypes were identified and characterized according to the following phenotypes: fluoroquinolone-resistant (FQR), extended-spectrum cephalosporin-resistant (ESCR), carbapenem-resistant (CR), or multidrug-resistant (MDR; as per Centers for Disease Control and Prevention criteria) GNB. Categories were not mutually exclusive. Results A total of 775 hospitalized adults and 357 community dwellers were enrolled. Among hospitalized subjects, the prevalence of colonization with FQR, ESCR, CR, or MDR-GNB was 46.4% (95% confidence interval [CI], 42.9–50.0), 41.2% (95% CI, 37.7–44.6), 14.5% (95% CI, 12.0–16.9), and 26.3% (95% CI, 23.2–29.4). In the community, the prevalence of FQR, ESCR, CR, and MDR-GNB colonization was 39.5% (95% CI, 34.4–44.6), 28.9% (95% CI, 24.2–33.6), 5.6% (95% CI, 3.2–8.0), and 4.8% (95% CI, 2.6–7.0), respectively. Conclusions A high burden of antimicrobial-resistant GNB colonization was observed in this sample of hospitalized and community-dwelling adults, suggesting that the community is a relevant source of antibiotic resistance. Efforts are needed to understand the relatedness between resistant strains circulating in the community and hospitals.

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“…This over-exploitation of antibiotics has over the years led to the fast emergence of multidrug-resistant bacteria or “superbugs”. The latter unfortunately continue to threaten humanity by rendering the treatment of bacterial diseases much more difficult ( Smith et al., 2021 ). Multidrug-resistant bacteria are resilient to three or more antibiotics to which they were previously susceptible but due to a number of possible factors, eventually developed resistance to these drugs.…”

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confidence: 99%

Identification of molecular determinants of antibiotic resistance in some fish farms of Ghana

Agbeko

Aheto

Asante

et al. 2022

Heliyon

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Human Colonization With Multidrug-Resistant Organisms: Getting to the Bottom of Antibiotic Resistance

Cited by 16 publications

References 12 publications

Prevalence of Colonization With Antibiotic-Resistant Organisms in Hospitalized and Community Individuals in Bangladesh, a Phenotypic Analysis: Findings From the Antibiotic Resistance in Communities and Hospitals (ARCH) Study

Prevalence of Colonization With Antibiotic-Resistant Organisms in Hospitalized and Community Individuals in Bangladesh, a Phenotypic Analysis: Findings From the Antibiotic Resistance in Communities and Hospitals (ARCH) Study

High Burden of Intestinal Colonization With Antimicrobial-Resistant Bacteria in Chile: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study

Identification of molecular determinants of antibiotic resistance in some fish farms of Ghana

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