Risk Factors for Colonization With Multidrug-Resistant Bacteria in Urban and Rural Communities in Kenya: An Antimicrobial Resistance in Communities and Hospitals (ARCH) Study.

Autor:	Caudell MA; Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA., Ayodo C; Washington State University Global Health-Kenya, Nairobi, Kenya., Ita T; Washington State University Global Health-Kenya, Nairobi, Kenya., Smith RM; Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Luvsansharav UO; Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Styczynski AR; Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Ramay BM; Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA.; Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala., Kariuki S; Kenya Medical Research Institute, Nairobi, Kenya., Palmer GH; Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA.; Washington State University Global Health-Kenya, Nairobi, Kenya.; University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya., Call DR; Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA., Omulo S; Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA.; Washington State University Global Health-Kenya, Nairobi, Kenya.; University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2023 Jul 05; Vol. 77 (Suppl 1), pp. S104-S110.
DOI:	10.1093/cid/ciad223
Abstrakt:	Background: Colonization with antimicrobial-resistant bacteria increases the risk of drug-resistant infections. We identified risk factors potentially associated with human colonization with extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) in low-income urban and rural communities in Kenya. Methods: Fecal specimens, demographic and socioeconomic data were collected cross-sectionally from clustered random samples of respondents in urban (Kibera, Nairobi County) and rural (Asembo, Siaya County) communities between January 2019 and March 2020. Presumptive ESCrE isolates were confirmed and tested for antibiotic susceptibility using the VITEK2 instrument. We used a path analytic model to identify potential risk factors for colonization with ESCrE. Only 1 participant was included per household to minimize household cluster effects. Results: Stool samples from 1148 adults (aged ≥18 years) and 268 children (aged <5 years) were analyzed. The likelihood of colonization increased by 12% with increasing visits to hospitals and clinics. Furthermore, individuals who kept poultry were 57% more likely to be colonized with ESCrE than those who did not. Respondents' sex, age, use of improved toilet facilities, and residence in a rural or urban community were associated with healthcare contact patterns and/or poultry keeping and may indirectly affect ESCrE colonization. Prior antibiotic use was not significantly associated with ESCrE colonization in our analysis. Conclusions: The risk factors associated with ESCrE colonization in communities include healthcare- and community-related factors, indicating that efforts to control antimicrobial resistance in community settings must include community- and hospital-level interventions. Competing Interests: Potential conflicts of interest. C. A., T. I., B. M. R., S. K., G. H. P., D. R. C., and S. O. report payments to their institutions from the Centers for Disease Control and Prevention (grant U01GH002143). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze:	MEDLINE
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