Increased Carriage of Macrolide-Resistant Fecal E. coli Following Mass Distribution of Azithromycin for Trachoma Control

Details

• Personal Author:
  Coles CL ; Johnson LB ; Levens J ; Mkocha H ; Muñoz B ; Seidman JC ; Silbergeld EK ; West SK
• Description:
  Background: Mass drug treatment with azithromycin (MDA) is part of the WHO-endorsed 'SAFE' strategy for trachoma control in endemic communities. MDA has been associated with reduced trachoma prevalence and short-term reductions in other bacterial infections, but can also lead to increased circulation of macrolide-resistant bacteria. Methods: We prospectively monitored macrolide resistance in fecal E. coli collected from young children participating in the PRETþ Study in rural Tanzania. MDA was administered in four villages with >10% trachoma prevalence. Four nearby communities with lower trachoma prevalence served as controls. Rectal swabs were collected during cross-sectional surveys performed at baseline, 1, 3 and 6 months after MDA. Fecal E. coli isolates were screened for macrolide susceptibility using disc diffusion and minimum inhibitory concentration methods. Cross-sectional and longitudinal differences in resistance prevalence by MDA exposure were compared using t-tests and logistic regression. Results: There was no difference in the proportion of individuals carrying azithromycin-resistant E. coli at baseline (0.21 vs 0.16, P>0.05). Azithromycin resistance carriage prevalence remained stable over follow-up in non-MDA villages but increased sharply in MDA villages (0.61 at 1 month, 0.42 at 3 months and 0.31 at 6 months). MDA exposure was highly associated with azithromycin resistance carriage at 1 month post-MDA (OR 15.27, P<0.001) and subsequent surveys. Younger age and recent diarrhoea were also associated with increased odds of resistance (P<0.01). Conclusions: MDA resulted in significantly increased prevalence of macrolide resistance in E. coli. Although MDA is effective for trachoma elimination, it has costs; it is essential to monitor antimicrobial resistance following MDA. [Description provided by NIOSH]
• Subjects:
  Anti-Bacterial Agents Communicable Diseases Community Health Services Drug Therapy Epidemiology Eye Occupational Health Race Factors Safety Sense Organs Sense Organs / Injuries

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• Keywords:
  Africa Antibacterial Agents Antibiotics Antimicrobial Resistance Author Keywords: Azithromycin Bacteria Bacterial Infections Children Community Health Cross Sectional Studies Diffusion Analysis Disease Control Disease Transmission Drugs Drug Therapy E. Coli Eye Damage Eye Diseases Eyes Global Health Infection Control Infectious Agents Infectious Diseases Intestinal Tissue Longitudinal Study Medical Screening Pathogens Racial Factors Regression Analysis Statistical Analysis

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• ISSN:
  0300-5771
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Maryland ; OSHA Region 3
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  43
• Issue:
  4
• NIOSHTIC Number:
  nn:20051841
• Citation:
  Int J Epidemiol 2014 Aug; 43(4):1105-1113
• Contact Point Address:
  Jessica C. Seidman, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA
• Email:
  jseidman@jhsph.edu
• CAS Registry Number:
  Azithromycin (CAS RN 83905-01-5)
• Federal Fiscal Year:
  2014
• Performing Organization:
  Johns Hopkins University - Baltimore
• Peer Reviewed:
  True
• Start Date:
  20090901
• Source Full Name:
  International Journal of Epidemiology
• End Date:
  20150831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:2167a3f8046e92ee42b63a1b7cd30202f02b8f2b122f3f04de983f4e92b52648c40a21be9f2ca68bd8996fba413f3bb02d9d12019458403de53772d14cd922f9
• Download URL:
  https://stacks.cdc.gov/view/cdc/211558/cdc_211558_DS1.pdf
• File Type:
  [PDF - 393.68 KB ]