1206. Risk Factors of Antibiotic Resistance in E. coli Isolated from the MAL-ED Birth Cohort Study in Rural Tanzania

Abstract

Background. The emergence and spread of antimicrobial resistance is a serious global public health crisis. Drug‐resistant Gram‐negative bacteria, like Escherichia coli, are particularly concerning given their significant morbidity and mortality. Despite the increasing prevalence of drug‐resistant Gram‐negative bacteria worldwide, there are significant knowledge gaps in low resource countries. We aimed to characterize the prevalence, phenotypes, and risk factors of drug‐resistant E. coli carriage in children up to age 5 from stool collected in the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL‐ED) birth cohort study in rural Tanzania. Methods. Two hundred sixty‐two children were enrolled in the MAL‐ED Tanzania site. We randomly selected 100 children who had E. coli specimens archived every 6 months through 60 months. Up to five lactose‐fermenting colonies were selected from growth on MacConkey agar. Drug susceptibility testing of 18 antibiotics was performed by disk diffusion. CLSI interpretive criteria were used for determination of resistance. Generalized estimating equations were used to create a multivariate Poisson regression model for drug resistance risk factors. Results. Eight hundred twenty‐three E. coli specimens were available for testing. The highest rates of resistance were to ampicillin, cefazolin, and cotrimoxazole, respectively. No carbapenem resistance was found. 1.8% met criteria for extended‐spectrum β‐lactamase production based on combination disk testing. 696 (84.6%) specimens met criteria for multi‐drug resistance (nonsusceptible to at least 1 drug in at least three drug categories). In terms of dynamic risk factors, there was no association between antibiotic use or episodes of diarrhea and antibiotic resistance. For static risk factors, there was an association between higher income and increased antibiotic resistance. Conclusion. Antibiotic resistance carriage is an under recognized problem in this setting. Resistance rates at 6 months of age are higher than expected, with surprisingly little variance explained by individual‐level risk factors for resistance in this community.