Kavulavu Briton M, Omwenga Eric O, Nyangiri Oscar Asanya, Nyerere Andrew K, Too Rael J, Matey Elizabeth J, Göpel Siri, Mogoa Wycliffe, Schilling Thorben, Hoelzle Ludwig E, Gladstone Beryl Primrose
Department of Medical Microbiology, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
Department of Medical Microbiology & Parasitology, School of Health Sciences, Kisii University, Kisii, Kenya.
PLoS One. 2025 Sep 3;20(9):e0331389. doi: 10.1371/journal.pone.0331389. eCollection 2025.
Antimicrobial resistance (AMR) is a major public health challenge, particularly in Sub-Saharan Africa, where diagnostic and surveillance capacities are limited. Enterobacterales significantly contribute to AMR, with environmental reservoirs facilitating transmission between humans, animals, and the environment.
This study investigated the prevalence and antimicrobial susceptibility of selected Enterobacterales in human, water, animal feces, and soil samples in Kenya. A cross-sectional study including 200 patients with gastrointestinal symptoms was conducted at Kisii Teaching and Referral Hospital and surrounding areas. AMR testing was performed using the disk diffusion method.
A total of 365 samples were collected: 200 human and 55 each of water, animal feces, and soil specimens from the homesteads of patients with resistant isolates. 343 isolates were obtained (Escherichia coli: 280/343 [81.6%], Salmonella spp.: 28/343 [8.2%], Klebsiella spp.: 25/343 [7.3%], Shigella spp.: 10/343 [2.9%]). A significant proportion of isolates exhibited AMR, particularly to piperacillin-tazobactam (up to 87%) and ampicillin (up to 79%). Resistance to piperacillin-tazobactam in E. coli was the highest, observed in humans (100/139, 71.9%), water (42/49, 85.7%), animal feces (9/46, 19.6%), and soil (33/46, 71.7%). Almost half (45%) of the human isolates showed ESBL production or resistance to imipenem, with water, animal feces, and soil samples, revealing similar resistance patterns. Resistance to chloramphenicol (71.7% vs 20.1%; p < 0.001) and third-generation cephalosporins were higher among animal and environmental isolates (animal feces: cefotaxime - 25/46, 54.3%; ceftazidime - 27/46, 58.7%) as compared to human isolates (cefotaxime - 40/139, 28.8%; ceftazidime - 28/139, 20.1%) (p < 0.001). In human isolates, the most prevalent genes were blaTEM (53/187, 28.3%), blaOXA-48 (43/187, 23.0%), blaSHV (32/187, 17.1%), and blaCTXM-15 (41/187, 21.9%); in animal isolates, blaCTXM-8 (11/55, 20.0%), blaVIM (8/55, 14.5%), and blaTEM (8/55, 14.5%) were most detected; while in soil and water isolates, blaCTXM-8 was the most common (10.9% and 9.1% respectively).
Shared resistance patterns across human, animal, and environmental samples highlight interconnected AMR pathways. These findings reinforce the need for a One Health approach through integrated AMR surveillance and interventions.
抗菌药物耐药性（AMR）是一项重大的公共卫生挑战，在撒哈拉以南非洲地区尤为突出，该地区的诊断和监测能力有限。肠杆菌科细菌对AMR的产生有显著影响，环境中的储存库促进了其在人类、动物和环境之间的传播。
本研究调查了肯尼亚人类、水、动物粪便和土壤样本中选定肠杆菌科细菌的流行情况和抗菌药物敏感性。在基苏木教学与转诊医院及周边地区开展了一项横断面研究，纳入200例有胃肠道症状的患者。采用纸片扩散法进行AMR检测。
共收集365份样本：200份人类样本，以及来自有耐药菌株患者家庭的水、动物粪便和土壤样本各55份。获得343株分离菌（大肠杆菌：280/343 [81.6%]，沙门氏菌属：28/343 [8.2%]，克雷伯菌属：25/343 [7.3%]，志贺菌属：10/343 [2.9%]）。相当一部分分离菌表现出AMR，尤其是对哌拉西林-他唑巴坦（高达87%）和氨苄西林（高达79%）。大肠杆菌对哌拉西林-他唑巴坦的耐药性最高，在人类样本（100/139，71.9%）、水样本（42/49，85.7%）、动物粪便样本（9/46，19.6%）和土壤样本（33/46，71.7%）中均有观察到。几乎一半（45%）的人类分离菌表现出超广谱β-内酰胺酶（ESBL）产生或对亚胺培南耐药，水、动物粪便和土壤样本显示出类似的耐药模式。动物和环境分离菌对氯霉素（71.7% 对20.1%；p < 0.001）和第三代头孢菌素的耐药性高于人类分离菌（动物粪便样本：头孢噻肟 - 25/46，54.3%；头孢他啶 - 27/46，58.7%）（人类样本：头孢噻肟 - 40/139，28.8%；头孢他啶 - 28/139，20.1%）（p < 0.001）。在人类分离菌中，最常见的基因是blaTEM（53/187，28.3%）、blaOXA - 48（43/187，23.0%）、blaSHV（32/187，17.1%）和blaCTXM - 15（41/187，21.9%）；在动物分离菌中，最常检测到的是blaCTXM - 8（11/55，20.0%）、blaVIM（8/55【此处原文可能有误，推测应为8/55】，14.5%）和blaTEM（8/55，14.5%）；而在土壤和水分离菌中，blaCTXM - 8最为常见（分别为10.9%和9.1%）。
人类、动物和环境样本中共同的耐药模式突出了AMR途径的相互联系。这些发现强化了通过综合AMR监测和干预措施采取“同一健康”方法的必要性。
