Infection and Drug Resistance (Oct 2022)
Correlation Between Individual Child-Level Antibiotic Consumption and Antibiotic-Resistant Among Commensal Escherichia coli: Results from a Cohort of Children Aged 1–3 Years in Rural Ujjain India
Abstract
Shweta Khare,1,2 Vishal Diwan,1,3 Ashish Pathak,1,4 Manju Raj Purohit,1,5,* Cecilia Stålsby Lundborg1,* 1Health Systems and Policy (HSP): Medicines, Focusing Antibiotics, Department of Global Public Health, Karolinska Institutet, Stockholm, 171 77, Sweden; 2Department of Public Health and Environment, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, 456006, India; 3Division of Environmental Monitoring and Exposure Assessment (Water and Soil), ICMR—National Institute for Research in Environmental Health, Bhopal, Madhya Pradesh, 462030, India; 4Department of Pediatrics, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, 456006, India; 5Department of Pathology, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, 456006, India*These authors contributed equally to this workCorrespondence: Shweta Khare, Health Systems and Policy (HSP): Medicines, Focusing Antibiotics, Department of Global Public Health, Karolinska Institutet, Stockholm, 171 77, Sweden, Tel +91 9893986241, Email [email protected]: The global expansion of antibiotic-resistant bacteria is a serious concern and is increasing worldwide in both pathogenic and commensal bacteria. The study determined the correlation between individual child-level antibiotic consumption and antibiotic resistance among the commensal Escherichia coli (E.coli) in a cohort of 125 children in rural Ujjain, India.Methods: During a two-year period between August 2014 and September 2016, stool samples were collected at seven-time points from a cohort of 125 children; aged 1– 3. A total of six colonies of E.coli per stool sample were collected for antibiotic susceptibility testing. Antibiotic consumption data was collected during the healthcare-seeking follow–up done during the same period. At each of the seven-time points correlation between antibiotic consumption (Defined Daily Dose-DDD/100 patient-days) and antibiotic resistance (number of resistant isolates) was analyzed independently using the Spearman correlation coefficient. Further, mixed-effects logistic regression models were built to study correlation between child-level consumption of penicillin with the number of E.coli isolates resistant to ampicillin, consumption of cephalosporin with resistance to cefotaxime and ceftazidime, consumption of fluoroquinolones with resistance to nalidixic acid and consumption of cotrimoxazole with resistance to cotrimoxazole.Results: Out of 756 illness episodes reported in 125 children 42% were with antibiotic prescriptions and reported a total antibiotic consumption of 55DDD/100 patient-days. The most common antibiotics used were cefixime (J01DD08;72 DDD/100patient/days) followed by ofloxacin (J01MA01;51DDD/100patient-days), cefpodoxime (J01DD13;38DDD/100patient-days) and amoxicillin (J01CA04;28DDD/100patient-days). The highest percentage of resistance was found to the ampicillin (67%) followed by nalidixic acid (52%) and cefotaxime (44%) and when summarized, more than 90% were resistant to cefotaxime, ceftazidime, and co-trimoxazole in commensal E.coli isolates. The consumption of cephalosporins showed weak positive correlation with the resistance to cefotaxime (Coefficient±SE=0.13 ± 0.09,p< 0.001).Conclusion: Our findings showed no correlation between individual-level antibiotic consumption and resistance development in commensal E.coli in a rural community environment.Keywords: Escherichia coli, Kirby Bauer disk diffusion method, healthcare-seeking behaviour, common childhood illness, caregivers, under-5 children, antibiotic prescribing, antibiotic resistance, rural population, India
