Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.
Washington State University Global Health-Kenya, Nairobi, Kenya.
Antimicrob Resist Infect Control. 2021 Jan 22;10(1):18. doi: 10.1186/s13756-021-00886-y.
The relationship between antibiotic use and antimicrobial resistance varies with cultural, socio-economic, and environmental factors. We examined these relationships in Kibera, an informal settlement in Nairobi-Kenya, characterized by high population density, high burden of respiratory disease and diarrhea.
Two-hundred households were enrolled in a 5-month longitudinal study. One adult (≥ 18 years) and one child (≤ 5 years) participated per household. Biweekly interviews (n = 1516) that included questions on water, sanitation, hygiene, and antibiotic use in the previous two weeks were conducted, and 2341 stool, 2843 hand swabs and 1490 drinking water samples collected. Presumptive E. coli (n = 34,042) were isolated and tested for susceptibility to nine antibiotics.
Eighty percent of presumptive E. coli were resistant to ≥ 3 antibiotic classes. Stool isolates were resistant to trimethoprim (mean: 81%), sulfamethoxazole (80%), ampicillin (68%), streptomycin (60%) and tetracycline (55%). Ninety-seven households reported using an antibiotic in at least one visit over the study period for a total of 144 episodes and 190 antibiotic doses. Enrolled children had five times the number of episodes reported by enrolled adults (96 vs. 19). Multivariable linear mixed-effects models indicated that children eating soil from the household yard and the presence of informal hand-washing stations were associated with increased numbers of antimicrobial-resistant bacteria (counts increasing by 0·27-0·80 log and 0·22-0·51 log respectively, depending on the antibiotic tested). Rainy conditions were associated with reduced carriage of antimicrobial-resistant bacteria (1·19 to 3·26 log depending on the antibiotic tested).
Antibiotic use provided little explanatory power for the prevalence of antimicrobial resistance. Transmission of resistant bacteria in this setting through unsanitary living conditions likely overwhelms incremental changes in antibiotic use. Under such circumstances, sanitation, hygiene, and disease transmission are the limiting factors for reducing the prevalence of resistant bacteria.
抗生素的使用与抗菌药物耐药性之间的关系因文化、社会经济和环境因素而异。我们在肯尼亚内罗毕的基贝拉（Kibera）进行了这项研究，这里是一个非正规住区，人口密度高，呼吸道疾病和腹泻负担沉重。
我们对 200 户家庭进行了为期 5 个月的纵向研究。每户家庭有一名成年人（≥18 岁）和一名儿童（≤5 岁）参加。我们每两周进行一次访谈（n=1516），询问过去两周内的水、卫生、卫生和抗生素使用情况，并采集了 2341 份粪便、2843 份手部拭子和 1490 份饮用水样本。我们分离并测试了 34042 株推定大肠埃希菌（E. coli）对 9 种抗生素的敏感性。
80%的推定大肠埃希菌对≥3 种抗生素类别的药物具有耐药性。粪便分离株对甲氧苄啶（mean: 81%）、磺胺甲噁唑（80%）、氨苄西林（68%）、链霉素（60%）和四环素（55%）具有耐药性。在研究期间，有 97 户家庭至少有一次报告在一次就诊中使用了抗生素，共发生了 144 例和 190 剂抗生素。与成年人报告的 19 例相比，入组儿童的病例数多了五倍（96 例）。多变量线性混合效应模型表明，儿童食用家庭院子里的土壤和存在非正式的洗手站与抗菌药物耐药菌数量的增加有关（根据测试的抗生素，细菌数量分别增加 0.27-0.80 对数和 0.22-0.51 对数）。降雨条件与抗菌药物耐药菌携带量减少有关（根据测试的抗生素，细菌数量减少 1.19-3.26 对数）。
抗生素的使用对抗菌药物耐药性的流行情况几乎没有解释力。在这种情况下，通过不卫生的生活条件传播耐药菌可能会超过抗生素使用的增量变化。在这种情况下，卫生、卫生和疾病传播是减少耐药菌流行的限制因素。
