title: Varying high levels of faecal carriage of extended-spectrum beta-lactamase producing Enterobacteriaceae in rural villages in Shandong, China: implications for global health.
abstract: Antibiotic resistance is considered a major threat to global health and is affected by many factors, of which antibiotic use is probably one of the more important. Other factors include hygiene, crowding and travel. The rapid resistance spread in Gram-negative bacteria, in particular extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae (ESBL-E), is a global challenge, leading to increased mortality, morbidity and health systems costs worldwide. Knowledge about resistance in commensal flora is limited, including in China. Our aim was to establish the faecal carriage rates of ESBL-E and find its association with known and suspected risk factors in rural residents of all ages in three socio-economically different counties in the Shandong Province, China. Faecal samples and risk-factor information (questionnaire) were collected in 2012. ESBL-E carriage was screened using ChromID ESBL agar. Risk factors were analysed using standard statistical methods. Data from 1000 individuals from three counties and in total 18 villages showed a high and varying level of ESBL-E carriage. Overall, 42% were ESBL-E carriers. At county level the carriage rates were 49%, 45% and 31%, respectively, and when comparing individual villages (n = 18) the rate varied from 22% to 64%. The high level of ESBL-E carriage among rural residents in China is an indication of an exploding global challenge in the years to come as resistance spreads among bacteria and travels around the world with the movement of people and freight. A high carriage rate of ESBL-E increases the risk of infection with multi-resistant bacteria, and thus the need for usage of last resort antibiotics, such as carbapenems and colistin, in the treatment of common infections.
authors.affiliation: Center for Health Management and Policy, Key Lab of Health Economics and Policy Research of Ministry of Health in Shandong University, Shandong University, Jinan, Shandong, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Sun
authors.affiliation: Clinical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Tärnberg
authors.affiliation: Center for Health Management and Policy, Key Lab of Health Economics and Policy Research of Ministry of Health in Shandong University, Shandong University, Jinan, Shandong, China.
authors.forename: Lingbo
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Stålsby Lundborg
authors.affiliation: School of Public Health, Shandong University, Jinan, Shandong, China.
authors.forename: Yanyan
authors.initials: Y
authors.lastname: Song
authors.affiliation: Antibiotics and Infection Control Unit, Public Health Agency of Sweden, Solna, Sweden.
authors.forename: Malin
authors.initials: M
authors.lastname: Grape
authors.affiliation: Clinical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Maud
authors.initials: M
authors.lastname: Nilsson
authors.affiliation: Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Medical Management Centre (MMC), Department of Learning, Informatics Management, Ethics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Tomson
authors.affiliation: Clinical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Lennart E
authors.initials: LE
authors.lastname: Nilsson
mesh_terms: D000367:Age Factors; D002681:China / Q000453:epidemiology; D004755:Enterobacteriaceae / Q000201:enzymology* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology*; D005243:Feces / Q000382:microbiology*; D006801:Humans; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001618:beta-Lactamases