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Evaluating the relationship between community water and sanitation access and the global burden of antibiotic resistance: an ecological study.
Fuhrmeister, Erica R; Harvey, Abigail P; Nadimpalli, Maya L; Gallandat, Karin; Ambelu, Argaw; Arnold, Benjamin F; Brown, Joe; Cumming, Oliver; Earl, Ashlee M; Kang, Gagandeep; Kariuki, Samuel; Levy, Karen; Pinto Jimenez, Chris E; Swarthout, Jenna M; Trueba, Gabriel; Tsukayama, Pablo; Worby, Colin J; Pickering, Amy J.
Affiliation
  • Fuhrmeister ER; Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA; Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA.
  • Harvey AP; Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA.
  • Nadimpalli ML; Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA; Gangarosa Department of Environmental Health, Emory Rollins School of Public Health, Atlanta, GA, USA.
  • Gallandat K; Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.
  • Ambelu A; Water and Health Division, Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia.
  • Arnold BF; Francis I Proctor Foundation, University of California, San Francisco, CA, USA.
  • Brown J; Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
  • Cumming O; Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.
  • Earl AM; Infectious Disease & Microbiome Program, Broad Institute, Cambridge, MA, USA.
  • Kang G; The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India.
  • Kariuki S; Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
  • Levy K; Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA.
  • Pinto Jimenez CE; Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
  • Swarthout JM; Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA.
  • Trueba G; Institutito de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador.
  • Tsukayama P; Laboratorio de Genómica Microbiana, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru.
  • Worby CJ; Infectious Disease & Microbiome Program, Broad Institute, Cambridge, MA, USA.
  • Pickering AJ; Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA; Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA; Chan Zuckerberg Biohub, San Francisco, CA, USA. Electronic address: pickering@berkeley.edu.
Lancet Microbe ; 4(8): e591-e600, 2023 08.
Article in En | MEDLINE | ID: mdl-37399829
ABSTRACT

BACKGROUND:

Antibiotic resistance is a leading cause of death, with the highest burden occurring in low-resource settings. There is little evidence on the potential for water, sanitation, and hygiene (WASH) access to reduce antibiotic resistance in humans. We aimed to determine the relationship between the burden of antibiotic resistance in humans and community access to drinking water and sanitation.

METHODS:

In this ecological study, we linked publicly available, geospatially tagged human faecal metagenomes (from the US National Center for Biotechnology Information Sequence Read Archive) with georeferenced household survey datasets that reported access to drinking water sources and sanitation facility types. We used generalised linear models with robust SEs to estimate the relationship between the abundance of antibiotic resistance genes (ARGs) in human faecal metagenomes and community-level coverage of improved drinking water and sanitation within a defined radii of faecal metagenome coordinates.

FINDINGS:

We identified 1589 metagenomes from 26 countries. The mean abundance of ARGs, in units of log10 ARG fragments per kilobase per million mapped reads classified as bacteria, was highest in Africa compared with Europe (p=0·014), North America (p=0·0032), and the Western Pacific (p=0·011), and second highest in South-East Asia compared with Europe (p=0·047) and North America (p=0·014). Increased access to improved water and sanitation was associated with lower ARG abundance (effect estimate -0·22, [95% CI -0·39 to -0·05]) and the association was stronger in urban (-0·32 [-0·63 to 0·00]) than in rural (-0·16 [-0·38 to 0·07]) areas.

INTERPRETATION:

Although additional studies to investigate causal effects are needed, increasing access to water and sanitation could be an effective strategy to curb the proliferation of antibiotic resistance in low-income and middle-income countries.

FUNDING:

Bill & Melinda Gates Foundation.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Drinking Water Type of study: Prognostic_studies Aspects: Determinantes_sociais_saude Limits: Humans Language: En Journal: Lancet Microbe Year: 2023 Document type: Article Affiliation country:
Fulltext
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Drinking Water Type of study: Prognostic_studies Aspects: Determinantes_sociais_saude Limits: Humans Language: En Journal: Lancet Microbe Year: 2023 Document type: Article Affiliation country: