1206. Risk Factors of Antibiotic Resistance in E. coli Isolated from the MAL-ED Birth Cohort Study in Rural Tanzania
Session: Poster Abstract Session: Healthcare Epidemiology: MDR-Gram Negative Infections
Friday, October 5, 2018
Room: S Poster Hall
  • IDWeek2018poster.pdf (298.6 kB)
  • Background: The emergence and spread of antimicrobial resistance is a serious global public health crisis. Drug-resistant gram-negative bacteria, like Escherichia coli, are particularly concerning given their significant morbidity and mortality. Despite the increasing prevalence of drug-resistant gram-negative bacteria worldwide, there are significant knowledge gaps in low resource countries. We aimed to characterize the prevalence , phenotypes, and risk factors of drug-resistant E. coli carriage in children up to age 5 from stool collected in the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) birth cohort study in rural Tanzania.

    Methods: 262 children were enrolled in the MAL-ED Tanzania site. We randomly selected 100 children who had E. coli specimens archived every 6 months through 60 months. Up to 5 lactose-fermenting colonies were selected from growth on MacConkey agar. Drug susceptibility testing of 18 antibiotics was performed by disk diffusion. CLSI interpretive criteria were used for determination of resistance. Generalized estimating equations were used to create a multivariate Poisson regression model for drug resistance risk factors.

    Results: 823 E. coli specimens were available for testing. The highest rates of resistance were to ampicillin, cefazolin, and cotrimoxazole, respectively. No carbapenem resistance was found. 1.8% met criteria for extended-spectrum beta-lactamase production based on combination disk testing. 696 (84.6%) specimens met criteria for multi-drug resistance (non-susceptible to at least 1 drug in at least 3 drug categories). In terms of dynamic risk factors, there was no association between antibiotic use or episodes of diarrhea and antibiotic resistance. For static risk factors, there was an association between higher income and increased antibiotic resistance.

    Conclusion: Antibiotic resistance carriage is an under recognized problem in this setting. Resistance rates at 6 months of age are higher than expected, with surprisingly little variance explained by individual level risk factors for resistance in this community.

    Molly Fleece, MD1, Rosemary Nshama, BSc2, Thomas Walongo, BSc2, Jean Gratz, BSc1, James Platts-Mills, MD1, Esto Mduma, MPH2 and Eric Houpt, MD, FIDSA1, (1)Division of Infectious Disease and International Health, University of Virginia, Charlottesville, VA, (2)Haydom Lutheran Hospital, Haydom, Tanzania, United Republic of


    M. Fleece, None

    R. Nshama, None

    T. Walongo, None

    J. Gratz, None

    J. Platts-Mills, None

    E. Mduma, None

    E. Houpt, None

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