Paul G. Allen School for Global Health, Washington State University, Pullman, WA, USA.
Washington State University Global Health-Kenya, Nairobi, Kenya.
Antimicrob Resist Infect Control. 2022 Aug 20;11(1):106. doi: 10.1186/s13756-022-01145-4.
Logistical and economic barriers hamper community-level surveillance for antimicrobial-resistant bacteria in low-income countries. Latrines are commonly used in these settings and offer a low-cost source of surveillance samples. It is unclear, however, whether antimicrobial resistance prevalence estimates from latrine samples reflect estimates generated from randomly sampled people.
We compared the prevalence of antimicrobial-resistant enteric bacteria from stool samples of people residing in randomly selected households within Kibera-an informal urban settlement in Kenya-to estimates from latrine samples within the same community. Fecal samples were collected between November 2015 and Jan 2016. Presumptive Escherichia coli isolates were collected from each household stool sample (n = 24) and each latrine sample (n = 48), resulting in 8935 and 8210 isolates, respectively. Isolates were tested for resistance to nine antibiotics using the replica-plating technique. Correlation- and Kolmogorov-Smirnov (K-S) tests were used to compare results.
Overall, the prevalence values obtained from latrine samples closely reflected those from stool samples, particularly for low-prevalence (< 15%) resistance phenotypes. Similarly, the distribution of resistance phenotypes was similar between latrine and household samples (r > 0.6; K-S p-values > 0.05).
Although latrine samples did not perfectly estimate household antimicrobial resistance prevalence, they were highly correlated and thus could be employed as low-cost samples to monitor trends in antimicrobial resistance, detect the emergence of new resistance phenotypes and assess the impact of community interventions.
在低收入国家，后勤和经济方面的障碍阻碍了社区层面对抗菌药物耐药细菌的监测。这些环境中通常使用厕所，为监测样本提供了低成本的来源。然而，尚不清楚来自厕所样本的抗菌药物耐药性流行率估计值是否反映了来自随机抽样人群的估计值。
我们比较了肯尼亚基贝拉一个非正规城市住区中随机选择的家庭居住者粪便样本中的肠道细菌对抗菌药物的耐药性流行率与同一社区中厕所样本的估计值。粪便样本于 2015 年 11 月至 2016 年 1 月间收集。从每个家庭的粪便样本（n=24）和每个厕所样本（n=48）中收集疑似大肠埃希菌分离株，分别产生 8935 株和 8210 株分离株。使用复制平板技术测试分离株对 9 种抗生素的耐药性。采用相关和柯尔莫哥洛夫-斯米尔诺夫（Kolmogorov-Smirnov，K-S）检验来比较结果。
总体而言，从厕所样本中获得的流行率值与从粪便样本中获得的值非常接近，尤其是对于低流行率（<15%）的耐药表型。同样，厕所和家庭样本中的耐药表型分布也相似（r>0.6；K-S p 值>0.05）。
虽然厕所样本不能完全估计家庭抗菌药物耐药流行率，但它们具有高度相关性，因此可以作为低成本样本用于监测抗菌药物耐药趋势、检测新耐药表型的出现以及评估社区干预措施的影响。
