Estimation of human feces-associated extended spectrum beta-lactamase-producing E. coli discharge into sanitation systems: a first global- and regional-scale calculation

Details

• Alternative Title:
  Lancet Planet Health
• Personal Author:
  Berendes, David ; Kirby, Amy ; Brown, Joe ; Wester, Astrid L.
• Description:
  Background:
  
  Improving management of and treatment within sanitation waste streams may slow the development and transmission of antimicrobial resistant (AMR) organisms, but the magnitude of impact has not been quantified. Extended-spectrum beta-lactamase-producing (ESBL) E. coli are an important cause of AMR infections and are frequently detected in fecal waste streams, making them model indicators of the distribution of fecal-oral AMR organisms.
  
  Methods:
  
  We used publicly-available sanitation coverage data and literature on human fecal production and ESBL E. coli carriage by healthy individuals to estimate the feces discharged containing ESBL E. coli by region through levels of the Sustainable Development Goal sanitation ladder.
  
  Findings:
  
  About 66% of the prospective global fecal biomass containing ESBL E. coli was managed in at least basic sanitation systems, 12% in limited sanitation, and 25% in unimproved sanitation (14%) or openly defecated (11%). Open defecation of ESBL E. coli was common in Southeast Asia (29%) and Africa (22%). Fecal biomass containing ESBL E. coli totaled 1.9–190 billion kg by carriage scenario, with 1.2–120 billion kg managed by at least basic sanitation and 220 million-22 billion kg openly defecated, and the remainder in limited or unimproved sanitation systems. Southeast Asia, Western Pacific, and Africa produced 63% of the total global fecal biomass, but 90% of feces containing ESBL E. coli.
  
  Interpretation:
  
  Although safely-managed and basic sanitation do not guarantee effective removal or inactivation of AMR organisms; our results indicate the need for mitigating AMR transport via unsafely-managed sanitation, including open defecation, which may result in direct environmental discharge and subsequent risk of transmission back to humans.
  
  Funding:
  
  No funding associated with this study.
  
  
• Subjects:
  Anti-Bacterial Agents Bacterial Proteins Beta-Lactamases Drug Resistance, Bacterial Escherichia Coli Escherichia Coli Infections Feces Humans Wastewater-Based Epidemiological Monitoring
• Source:
  Lancet Planet Health. 4(6):e246-e255
• Pubmed ID:
  32559441
• Pubmed Central ID:
  PMC10906806
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  4
• Issue:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:722ff7dfc27a759c1e676789abd47bb4db5f88dca05d3d6bd58bd0dfde8211f12b16e4c9e57e7b9c17863ed293664d9a86cc50168ecc639f401932644b402c6d
• Download URL:
  https://stacks.cdc.gov/view/cdc/150391/cdc_150391_DS1.pdf
• File Type:
  [PDF - 549.89 KB ]