Gastrointestinal Carriage of Antimicrobial Resistance in School-Aged Children in Three Municipalities of Timor-Leste

Tessa Oakley; Brandon Le; Virginia da Conceicao; Ian Marr; Joana Correia Belo; Carolina Maia; Messias Soares; Nevio Sarmento; Endang da Silva; Salvador Amaral; Susana Vaz Nery; Sarah Lynar; Joshua R. Francis; Jennifer Yan

doi:10.3390/antibiotics11091262

Gastrointestinal Carriage of Antimicrobial Resistance in School-Aged Children in Three Municipalities of Timor-Leste

Tessa Oakley, Brandon Le, Virginia da Conceicao, Ian Marr, Joana Correia Belo, Carolina Maia, Messias Soares, Nevio Sarmento, Endang da Silva, Salvador Amaral, Susana Vaz Nery, Sarah Lynar, Joshua R. Francis, Jennifer Yan

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Abstract

Invasive bacterial infections are a leading cause of death in children, primarily in low- and middle-income countries (LMIC). Links between carriage of antimicrobial-resistant organisms and more resistant infections have been established; however, little has been reported regarding community carriage of antibiotic-resistant organisms such as extended-spectrum β-lactamase (ESBL)-producing Enterobacterales in LMIC. The aim of this study was to determine colonic carriage of ESBL-producing fluoroquinolone- and aminoglycoside-resistant Enterobacterales in healthy children in three municipalities of Timor-Leste. In November 2020, 621 stool samples were collected from school-aged children and underwent screening for the presence of Enterobacterales species and antimicrobial resistance (AMR). Ciprofloxacin-resistant Gram-negative organisms were cultured from 16.5% (95% CI 6.2–26.9), and gentamicin resistance was identified in 6.8% (95% CI 2.8–10.7). Compared to the prevalence of ciprofloxacin resistance in Dili (36.1%), there was significantly lower prevalence in the rural municipalities of Ermera (12.9%; AOR 0.38, 95% CI 0.24–0.60, p < 0.001) and Manufahi (4.5%; AOR 0.07, 95% CI 0.01–0.51, p = 0.009). The overall cluster-adjusted prevalence of ESBL-producing bacteria was 8.3%, with no significant differences between municipalities. This study demonstrates high rates of carriage of AMR among school-aged children in Timor-Leste, with higher rates observed in Dili compared to rural municipalities. Empiric antibiotic guidelines should include recommendations for treating community-acquired infections that account for the possibility of antimicrobial resistance.

Original language	English
Article number	1262
Pages (from-to)	1-8
Number of pages	8
Journal	Antibiotics
Volume	11
Issue number	9
DOIs	https://doi.org/10.3390/antibiotics11091262
Publication status	Published - 16 Sept 2022

Bibliographical note

Funding Information:
This work was made possible through the support of the Fleming Fund Country Grant for Timor-Leste (FF/17/233), which has facilitated significant improvements in laboratory capacity for diagnosis and surveillance of antimicrobial resistance in Timor-Leste. The Fleming Fund is a UK aid investment programme to tackle antimicrobial resistance in low- and middle-income countries around the world and is managed by the UK Department of Health and Social Care.

Publisher Copyright:
© 2022 by the authors.

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10.3390/antibiotics11091262

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Oakley, T., Le, B., da Conceicao, V., Marr, I., Belo, J. C., Maia, C., Soares, M., Sarmento, N., da Silva, E., Amaral, S., Vaz Nery, S., Lynar, S., Francis, J. R., & Yan, J. (2022). Gastrointestinal Carriage of Antimicrobial Resistance in School-Aged Children in Three Municipalities of Timor-Leste. Antibiotics, 11(9), 1-8. Article 1262. https://doi.org/10.3390/antibiotics11091262

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title = "Gastrointestinal Carriage of Antimicrobial Resistance in School-Aged Children in Three Municipalities of Timor-Leste",

abstract = "Invasive bacterial infections are a leading cause of death in children, primarily in low- and middle-income countries (LMIC). Links between carriage of antimicrobial-resistant organisms and more resistant infections have been established; however, little has been reported regarding community carriage of antibiotic-resistant organisms such as extended-spectrum β-lactamase (ESBL)-producing Enterobacterales in LMIC. The aim of this study was to determine colonic carriage of ESBL-producing fluoroquinolone- and aminoglycoside-resistant Enterobacterales in healthy children in three municipalities of Timor-Leste. In November 2020, 621 stool samples were collected from school-aged children and underwent screening for the presence of Enterobacterales species and antimicrobial resistance (AMR). Ciprofloxacin-resistant Gram-negative organisms were cultured from 16.5% (95% CI 6.2–26.9), and gentamicin resistance was identified in 6.8% (95% CI 2.8–10.7). Compared to the prevalence of ciprofloxacin resistance in Dili (36.1%), there was significantly lower prevalence in the rural municipalities of Ermera (12.9%; AOR 0.38, 95% CI 0.24–0.60, p < 0.001) and Manufahi (4.5%; AOR 0.07, 95% CI 0.01–0.51, p = 0.009). The overall cluster-adjusted prevalence of ESBL-producing bacteria was 8.3%, with no significant differences between municipalities. This study demonstrates high rates of carriage of AMR among school-aged children in Timor-Leste, with higher rates observed in Dili compared to rural municipalities. Empiric antibiotic guidelines should include recommendations for treating community-acquired infections that account for the possibility of antimicrobial resistance.",

keywords = "AMR, colonisation, E. coli, Enterobacterales, ESBL, multidrug-resistant, third-generation cephalosporins",

author = "Tessa Oakley and Brandon Le and {da Conceicao}, Virginia and Ian Marr and Belo, {Joana Correia} and Carolina Maia and Messias Soares and Nevio Sarmento and {da Silva}, Endang and Salvador Amaral and {Vaz Nery}, Susana and Sarah Lynar and Francis, {Joshua R.} and Jennifer Yan",

note = "Funding Information: This work was made possible through the support of the Fleming Fund Country Grant for Timor-Leste (FF/17/233), which has facilitated significant improvements in laboratory capacity for diagnosis and surveillance of antimicrobial resistance in Timor-Leste. The Fleming Fund is a UK aid investment programme to tackle antimicrobial resistance in low- and middle-income countries around the world and is managed by the UK Department of Health and Social Care. Publisher Copyright: {\textcopyright} 2022 by the authors.",

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doi = "10.3390/antibiotics11091262",

language = "English",

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T1 - Gastrointestinal Carriage of Antimicrobial Resistance in School-Aged Children in Three Municipalities of Timor-Leste

AU - Oakley, Tessa

AU - Le, Brandon

AU - da Conceicao, Virginia

AU - Marr, Ian

AU - Belo, Joana Correia

AU - Maia, Carolina

AU - Soares, Messias

AU - Sarmento, Nevio

AU - da Silva, Endang

AU - Amaral, Salvador

AU - Vaz Nery, Susana

AU - Lynar, Sarah

AU - Francis, Joshua R.

AU - Yan, Jennifer

N1 - Funding Information: This work was made possible through the support of the Fleming Fund Country Grant for Timor-Leste (FF/17/233), which has facilitated significant improvements in laboratory capacity for diagnosis and surveillance of antimicrobial resistance in Timor-Leste. The Fleming Fund is a UK aid investment programme to tackle antimicrobial resistance in low- and middle-income countries around the world and is managed by the UK Department of Health and Social Care. Publisher Copyright: © 2022 by the authors.

PY - 2022/9/16

Y1 - 2022/9/16

N2 - Invasive bacterial infections are a leading cause of death in children, primarily in low- and middle-income countries (LMIC). Links between carriage of antimicrobial-resistant organisms and more resistant infections have been established; however, little has been reported regarding community carriage of antibiotic-resistant organisms such as extended-spectrum β-lactamase (ESBL)-producing Enterobacterales in LMIC. The aim of this study was to determine colonic carriage of ESBL-producing fluoroquinolone- and aminoglycoside-resistant Enterobacterales in healthy children in three municipalities of Timor-Leste. In November 2020, 621 stool samples were collected from school-aged children and underwent screening for the presence of Enterobacterales species and antimicrobial resistance (AMR). Ciprofloxacin-resistant Gram-negative organisms were cultured from 16.5% (95% CI 6.2–26.9), and gentamicin resistance was identified in 6.8% (95% CI 2.8–10.7). Compared to the prevalence of ciprofloxacin resistance in Dili (36.1%), there was significantly lower prevalence in the rural municipalities of Ermera (12.9%; AOR 0.38, 95% CI 0.24–0.60, p < 0.001) and Manufahi (4.5%; AOR 0.07, 95% CI 0.01–0.51, p = 0.009). The overall cluster-adjusted prevalence of ESBL-producing bacteria was 8.3%, with no significant differences between municipalities. This study demonstrates high rates of carriage of AMR among school-aged children in Timor-Leste, with higher rates observed in Dili compared to rural municipalities. Empiric antibiotic guidelines should include recommendations for treating community-acquired infections that account for the possibility of antimicrobial resistance.

AB - Invasive bacterial infections are a leading cause of death in children, primarily in low- and middle-income countries (LMIC). Links between carriage of antimicrobial-resistant organisms and more resistant infections have been established; however, little has been reported regarding community carriage of antibiotic-resistant organisms such as extended-spectrum β-lactamase (ESBL)-producing Enterobacterales in LMIC. The aim of this study was to determine colonic carriage of ESBL-producing fluoroquinolone- and aminoglycoside-resistant Enterobacterales in healthy children in three municipalities of Timor-Leste. In November 2020, 621 stool samples were collected from school-aged children and underwent screening for the presence of Enterobacterales species and antimicrobial resistance (AMR). Ciprofloxacin-resistant Gram-negative organisms were cultured from 16.5% (95% CI 6.2–26.9), and gentamicin resistance was identified in 6.8% (95% CI 2.8–10.7). Compared to the prevalence of ciprofloxacin resistance in Dili (36.1%), there was significantly lower prevalence in the rural municipalities of Ermera (12.9%; AOR 0.38, 95% CI 0.24–0.60, p < 0.001) and Manufahi (4.5%; AOR 0.07, 95% CI 0.01–0.51, p = 0.009). The overall cluster-adjusted prevalence of ESBL-producing bacteria was 8.3%, with no significant differences between municipalities. This study demonstrates high rates of carriage of AMR among school-aged children in Timor-Leste, with higher rates observed in Dili compared to rural municipalities. Empiric antibiotic guidelines should include recommendations for treating community-acquired infections that account for the possibility of antimicrobial resistance.

KW - AMR

KW - colonisation

KW - E. coli

KW - Enterobacterales

KW - ESBL

KW - multidrug-resistant

KW - third-generation cephalosporins

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DO - 10.3390/antibiotics11091262

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JF - Antibiotics

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M1 - 1262

ER -

Gastrointestinal Carriage of Antimicrobial Resistance in School-Aged Children in Three Municipalities of Timor-Leste

Abstract

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