水源、厕所类型和降雨量与阴道微生物群中检测到的非最佳细菌和肠道细菌有关：一项嵌套在整群随机对照试验中的前瞻性观察队列研究。
Water source, latrine type, and rainfall are associated with detection of non-optimal and enteric bacteria in the vaginal microbiome: a prospective observational cohort study nested within a cluster randomized controlled trial.
作者信息
Czapar Anna E, Paul Souvik, Zulaika Garazi, Otieno Fredrick, Agingu Walter, Chaudhary Adit, Bhaumik Runa, van Eijk Anna Maria, Green Stefan J, Nyothach Elizabeth, Phillips-Howard Penelope A, Mehta Supriya D
机构信息
Department of Medicine, Division of Infectious Diseases, Loyola University Stritch School of Medicine, Maywood, USA.
Division of Epidemiology & Biostatistics, University of Illinois Chicago School of Public Health, Chicago, USA.
出版信息
BMC Infect Dis. 2024 Dec 18;24(1):1419. doi: 10.1186/s12879-024-10313-3.
BACKGROUND
Less than one-third of sub-Saharan Africans have access to improved water sources. In US, Indian, and African studies, Bacterial vaginosis (BV) is increased among women with poor water, sanitation, and hygiene (WASH). We examined water source, sanitation (latrine type), and rainfall in relation to the vaginal microbiome (VMB).
METHODS
In a cluster randomized controlled trial of menstrual cups and cash transfer, we measured the impact of cups on VMB via 16S rRNA gene amplicon sequencing in a subset of 436 adolescent girls. We analyzed how self-reported water source and latrine type at home related to VMB over 18-months, examining community state type I (CST-I, L. crispatus dominant) vs. other CST; alpha diversity; targeted taxa (coliform and other water-related pathogens); and non-targeted taxa via machine learning approaches. Mixed effects multivariable longitudinal models were adjusted for intervention arm, age, socioeconomic status, sexual activity, and cluster-level school WASH and rainfall (in millimeters).
RESULTS
Adjusting for all covariates in all models: (1) the odds of CST-I were increased among participants with piped water (vs. pond), and decreased with traditional pit latrine vs. flush toilet. (2) Alpha diversity varied by water source and latrine type without consistent trends. (3) Coliform bacteria relative abundance (RA) was higher among participants with traditional pit or ventilated improved pit latrines vs. flush toilet, and higher among participants relying on stream vs. pond water. Streptococcus agalactiae RA was higher among participants with non-flush toilets, while Bacteroides fragilis RA was lower with non-flush toilets. (4) Key taxa from non-targeted analyses associated with water source and latrine type included typical vaginal bacteria, opportunistic pathogens, and urinary tract pathobionts. (6) Increased rainfall was associated with decreased odds of CST-I.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03051789, February 14, 2017.
背景
撒哈拉以南非洲地区只有不到三分之一的人能够使用改良水源。在美国、印度和非洲的研究中，水、环境卫生和个人卫生条件（WASH）较差的女性患细菌性阴道病（BV）的几率更高。我们研究了水源、卫生设施（厕所类型）和降雨量与阴道微生物群（VMB）的关系。
方法
在一项月经杯和现金转移的整群随机对照试验中，我们通过对436名青春期女孩的子集进行16S rRNA基因扩增子测序，测量了月经杯对VMB的影响。我们分析了18个月内自我报告的家庭水源和厕所类型与VMB的关系，研究了社区状态类型I（CST-I，以卷曲乳杆菌为主）与其他CST；α多样性；目标分类群（大肠菌群和其他与水相关的病原体）；以及通过机器学习方法分析非目标分类群。混合效应多变量纵向模型针对干预组、年龄、社会经济地位、性活动以及社区层面的学校水、环境卫生和降雨量（以毫米为单位）进行了调整。
结果
在所有模型中对所有协变量进行调整后：（1）使用自来水（与池塘水相比）的参与者中CST-I的几率增加，而使用传统坑式厕所（与冲水马桶相比）的参与者中CST-I的几率降低。（2）α多样性因水源和厕所类型而异，没有一致的趋势。（3）使用传统坑式或通风改良坑式厕所的参与者中大肠菌群相对丰度（RA）高于使用冲水马桶的参与者，依赖溪水（与池塘水相比）的参与者中大肠菌群相对丰度更高。无冲水马桶的参与者中无乳链球菌RA更高，而无冲水马桶的参与者中脆弱拟杆菌RA更低。（4）非目标分析中与水源和厕所类型相关的关键分类群包括典型的阴道细菌、机会性病原体和泌尿道致病共生菌。（6）降雨量增加与CST-I几率降低相关。
试验注册
ClinicalTrials.gov NCT03051789，2017年2月14日。
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