Berkeley School of Public Health, University of California, Berkeley, CA, USA.
Microbiology Institute, Colegio de Ciencias Biologicas Y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador.
Antimicrob Resist Infect Control. 2021 Jan 6;10(1):2. doi: 10.1186/s13756-020-00867-7.
The rapid spread of extended-spectrum beta-lactamase-producing E. coli (ESBL-EC) is an urgent global health threat. We examined child caretaker knowledge, attitudes, and practices (KAP) towards proper antimicrobial agent use and whether certain KAP were associated with ESBL-EC colonization of their children.
Child caretakers living in semi-rural neighborhoods in peri-urban Quito, Ecuador were visited and surveyed about their KAP towards antibiotics. Fecal samples from one child (less than 5 years of age) per household were collected at two time points between July 2018 and May 2019 and screened for ESBL-EC. A repeated measures analysis with logistic regression was used to assess the relationship between KAP levels and child colonization with ESBL-EC.
We analyzed 740 stool samples from 444 children living in households representing a range of environmental conditions. Of 374 children who provided fecal samples at the first household visit, 44 children were colonized with ESBL-EC (11.8%) and 161 were colonized with multidrug-resistant E. coli (43%). The prevalences of ESBL-EC and multidrug-resistant E. coli were similar at the second visit (11.2% and 41.3%, respectively; N = 366). Only 8% of caretakers knew that antibiotics killed bacteria but not viruses, and over a third reported that they "always" give their children antibiotics when the child's throat hurts (35%). Few associations were observed between KAP variables and ESBL-EC carriage among children. The odds of ESBL-EC carriage were 2.17 times greater (95% CI: 1.18-3.99) among children whose caregivers incorrectly stated that antibiotics do not kill bacteria compared to children whose caregivers correctly stated that antibiotics kill bacteria. Children from households where the caretaker answered the question "When your child's throat hurts, do you give them antibiotics?" with "sometimes" had lower odds of ESBL-EC carriage than those with a caretaker response of "never" (OR 0.48, 95% CI 0.27-0.87).
Caregivers in our study population generally demonstrated low knowledge regarding appropriate use of antibiotics. Our findings suggest that misinformation about the types of infections (i.e. bacterial or viral) antibiotics should be used for may be associated with elevated odds of carriage of ESBL-EC. Understanding that using antibiotics is appropriate to treat infections some of the time may reduce the odds of ESBL-EC carriage. Overall, however, KAP measures of appropriate use of antibiotics were not strongly associated with ESBL-EC carriage. Other individual- and community-level environmental factors may overshadow the effect of KAP on ESBL-EC colonization. Intervention studies are needed to assess the true effect of improving KAP on laboratory-confirmed carriage of antimicrobial resistant bacteria, and should consider community-level studies for more effective management.
产超广谱β-内酰胺酶大肠埃希菌（ESBL-EC）的迅速传播是一个紧迫的全球健康威胁。我们研究了儿童看护者对适当使用抗菌药物的知识、态度和实践（KAP），以及某些 KAP 是否与他们孩子的 ESBL-EC 定植有关。
我们对厄瓜多尔基多周边农村地区的半农村社区的儿童看护者进行了访问和调查，了解他们对抗生素的 KAP。在 2018 年 7 月至 2019 年 5 月期间的两个时间点，从每个家庭的一名（<5 岁）儿童收集粪便样本，并对其进行 ESBL-EC 筛查。采用重复测量分析和逻辑回归评估 KAP 水平与儿童 ESBL-EC 定植之间的关系。
我们分析了来自 444 名儿童的 740 份粪便样本，这些儿童来自各种环境条件的家庭。在第一次家庭访问时提供粪便样本的 374 名儿童中，有 44 名儿童定植 ESBL-EC（11.8%），161 名儿童定植多药耐药大肠埃希菌（43%）。第二次访问时，ESBL-EC 和多药耐药大肠埃希菌的流行率相似（分别为 11.2%和 41.3%；N=366）。只有 8%的看护者知道抗生素可以杀死细菌但不能杀死病毒，超过三分之一的人报告说，当孩子喉咙痛时，他们“总是”给孩子服用抗生素（35%）。在儿童中，很少观察到 KAP 变量与 ESBL-EC 携带之间存在关联。与看护者正确回答抗生素杀死细菌的儿童相比，看护者错误回答抗生素不杀死细菌的儿童携带 ESBL-EC 的几率高 2.17 倍（95%CI：1.18-3.99）。在看护者回答“当孩子的喉咙痛时，你给他们服用抗生素吗？”为“有时”的家庭中，儿童携带 ESBL-EC 的几率低于回答“从不”的家庭（OR 0.48，95%CI 0.27-0.87）。
我们研究人群中的看护者普遍对适当使用抗生素的知识了解不足。我们的研究结果表明，关于抗生素应用于何种类型感染（即细菌或病毒）的错误信息可能与 ESBL-EC 携带的几率升高有关。了解抗生素在某些情况下用于治疗感染可能会降低 ESBL-EC 携带的几率。然而，总体而言，抗生素适当使用的 KAP 措施与 ESBL-EC 携带的相关性并不强。个体和社区环境因素可能会影响 KAP 对 ESBL-EC 定植的影响。需要进行干预研究来评估提高 KAP 对实验室确认的耐抗生素细菌携带的真实影响，并且应该考虑社区层面的研究以进行更有效的管理。
