Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, UK; International Livestock Research Institute, Nairobi, Kenya.
Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
Int J Antimicrob Agents. 2019 Nov;54(5):531-537. doi: 10.1016/j.ijantimicag.2019.08.014. Epub 2019 Aug 19.
There are substantial limitations in understanding of the distribution of antimicrobial resistance (AMR) in humans and livestock in developing countries. This papers present the results of an epidemiological study examining patterns of AMR in Escherichia coli isolates circulating in sympatric human (n = 321) and livestock (n = 633) samples from 99 households across Nairobi, Kenya. E. coli isolates were tested for susceptibility to 13 antimicrobial drugs representing nine antibiotic classes. High rates of AMR were detected, with 47.6% and 21.1% of isolates displaying resistance to three or more and five or more antibiotic classes, respectively. Human isolates showed higher levels of resistance to sulfonamides, trimethoprim, aminoglycosides and penicillins compared with livestock (P<0.01), while poultry isolates were more resistant to tetracyclines (P = 0.01) compared with humans. The most common co-resistant phenotype observed was to tetracyclines, streptomycin and trimethoprim (30.5%). At the household level, AMR carriage in humans was associated with human density (P<0.01) and the presence of livestock manure (P = 0.03), but keeping livestock had no influence on human AMR carriage (P>0.05). These findings revealed a high prevalence of AMR E. coli circulating in healthy humans and livestock in Nairobi, with no evidence to suggest that keeping livestock, when treated as a single risk factor, contributed significantly to the burden of AMR in humans, although the presence of livestock waste was significant. These results provide an understanding of the broader epidemiology of AMR in complex and interconnected urban environments.
发展中国家在理解人类和家畜中抗生素耐药性（AMR）的分布方面存在很大的局限性。本文介绍了一项流行病学研究的结果，该研究调查了在肯尼亚内罗毕的 99 户家庭中，共存的人类（n=321）和家畜（n=633）样本中循环的大肠杆菌分离株中 AMR 模式。对大肠杆菌分离株进行了 13 种代表 9 种抗生素类别的抗菌药物敏感性测试。检测到了很高的 AMR 率，分别有 47.6%和 21.1%的分离株对三种或三种以上和五种或五种以上抗生素类别的药物表现出耐药性。与家畜相比，人类分离株对磺胺类药物、甲氧苄啶、氨基糖苷类和青霉素的耐药性水平更高（P<0.01），而家禽分离株对四环素的耐药性（P=0.01）高于人类。观察到的最常见的共同耐药表型是对四环素、链霉素和甲氧苄啶（30.5%）。在家庭层面，人类 AMR 携带与人类密度（P<0.01）和家畜粪便的存在（P=0.03）有关，但饲养家畜对人类 AMR 携带没有影响（P>0.05）。这些发现表明，在奈洛比，健康的人类和家畜中循环的 AMR 大肠杆菌具有很高的流行率，没有证据表明，将家畜作为单一的危险因素来饲养，会对人类 AMR 的负担有显著贡献，尽管家畜粪便的存在是显著的。这些结果提供了对复杂和相互关联的城市环境中 AMR 更广泛的流行病学的理解。
