title: Longitudinal Comparison of Antibiotic Resistance in Diarrheagenic and Non-pathogenic Escherichia coli from Young Tanzanian Children.
abstract: Enteroaggregative, enteropathogenic, and enterotoxigenic Escherichia coli contribute significantly to the burden of diarrheal infections particularly in developing countries. Antibiotic resistance is increasingly common among bacterial pathogens including pathogenic E. coli. We assessed the relationship between pathogenic E. coli carriage and resistance to six antibiotics in E. coli isolated from young children in rural Tanzania. We surveyed temporal stability in antibiotic resistance in 2492 E. coli isolated from fecal samples obtained from young children in rural Tanzania collected over a 6 months period. Approximately half of the 377 children sampled were exposed to an azithromycin mass treatment program for trachoma control and half resided in control villages. Children were sampled at baseline, 1-, 3-, and 6 months following azithromycin treatment. We compared resistance to six antibiotics in pathogenic and non-pathogenic strains at the population level, within fecal specimens, and within individuals over time using chi-square tests, paired odds ratios, and logistic regression, respectively. Resistance to ampicillin and trimethoprim/sulfamethoxazole was highly prevalent (>65%). Resistance to 5 of 6 antibiotics tested and multi-drug resistance occurred more frequently in pathogenic isolates (p ≤ 0.001) within fecal specimens and overall. Azithromycin mass treatment exposure was significantly associated with increased odds of carriage of isolates resistant to erythromycin (OR 3.64, p < 0.001) and trimethoprim/sulfamethoxazole (OR 1.60, p < 0.05). Pathogenic isolates were approximately twice as likely to be resistant to erythromycin, ampicillin, or trimethoprim/sulfamethoxazole compared to non-pathogenic isolates from the same fecal specimen. The potential linkage between resistance and virulence in E. coli suggests hygiene and sanitation interventions aimed at reducing disease burden could play a role in controlling transmission of antibiotic resistance.
authors.affiliation: Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD USA.
authors.forename: Jessica C
authors.initials: JC
authors.lastname: Seidman
authors.affiliation: Biology Department, Morgan State University, Baltimore, MD USA.
authors.forename: Lashaunda B
authors.initials: LB
authors.lastname: Johnson
authors.affiliation: CTS Global, Dar es Salaam Tanzania.
authors.forename: Joshua
authors.initials: J
authors.lastname: Levens
authors.affiliation: Kongwa Trachoma Project, Kongwa Tanzania.
authors.forename: Harran
authors.initials: H
authors.lastname: Mkocha
authors.affiliation: Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD USA.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Muñoz
authors.affiliation: Department of Environmental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA.
authors.forename: Ellen K
authors.initials: EK
authors.lastname: Silbergeld
authors.affiliation: Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD USA.
authors.forename: Sheila K
authors.initials: SK
authors.lastname: West
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA.
authors.forename: Christian L
authors.initials: CL
authors.lastname: Coles
keywords: Tanzania; antibiotic resistance; children; diarrheagenic E. coli; non-pathogenic E. coli