Research Article: Prevalence of antibiotic resistance in commensal Escherichia coli among the children in rural hill communities of Northeast India

Date Published: June 18, 2018

Publisher: Public Library of Science

Author(s): Ashish Kumar Singh, Saurav Das, Samer Singh, Varsha Rani Gajamer, Nilu Pradhan, Yangchen Doma Lepcha, Hare Krishna Tiwari, Udai Pandey.


Commensal bacteria are the representative of the reservoir of antibiotic resistance genes present in a community. The usage of antibiotics along with the demographic factors is generally associated with an increase in antibiotics resistance in pathogens. Northeast (NE) India is untapped with regard to antibiotic resistance prevalence and spread. In the current study, the prevalence of antibiotic-resistant commensal Escherichia coli in pre-school and school-going children (n = 550, 1–14 years old) from the rural areas of the state of Sikkim—an NE Indian state, with respect to associated demographic factors was investigated. A total of 550 fecal E. coli isolates were collected during July 2015 to June 2017. A structured questionnaire was used to collect data to ascertain the potential factors associated with the carriage of antibiotic resistance E. coli among the children. Statistical analysis along with a logistic regression identified potential external factors affecting the observed antibiotic resistance pattern. The data indicated a high prevalence of resistance to common antibiotics like ampicillin (92%), ceftazidime (90%), cefoxitin (88%), streptomycin (40%) and tetracycline (36%), but no resistance to chloramphenicol. The resistance to the combination of penicillin and quinolone group of antibiotics was observed in fifty-two percent of the isolates. A positive correlation between the harboring of antibiotics resistant E. coli with different demographic factors was observed such as, with children living in nuclear family (vs joint family 63.15%, OR 0.18, 95% CI:0.11–0.28, p < 0.01), below higher secondary maternal education (vs college graduates 59.27% OR 0.75, 95% CI:0.55–1.02, p < 0.02). A close association between different demographic factors and the high prevalence of antibiotic-resistant commensal E. coli in the current study suggests a concern over rising misuse of antibiotics that warrants a future threat of emergence of multidrug-resistant pathogen isolates.

Partial Text

During the last decade, an alarming worldwide increase in the incidence of community-acquired infections with pathogens resistant to multiple antibiotics of common use has been observed [1]. Use of antibiotics plays a crucial role in the emergence of antibiotic resistance amongst pathogenic bacteria worldwide as well as in developing countries [2] [3] [4]. However, to counter the prevailing scenario, very few new antibiotics have been introduced in the last three decades [5]. Inappropriate use of antimicrobials is considered to be one of the main factors responsible for the high prevalence of antibiotic-resistant pathogens in developing countries [4]. Increased antibiotic resistance in pathogens leads to increased mortality and morbidity, enhanced transmission and increased associated health care costs [6].

The demographic details of the families of 550 children from whom E. coli were isolated are summarized in Fig 2. The median age of children included in the study was 8.5 years for males and 8 years for females. Twenty-six percent (n = 143) of the children had a history of gastrointestinal illness in the last three weeks prior to the survey and they were on antibiotics. Among the 550 E. coli isolates from 550 children, 90% percent (n = 495) were found to be resistant to at least one of the commonly used antibiotics (ADR). Multidrug resistance (MDR) was displayed by > one-fourth of the isolates (41%, n = 226) while only 3% of the isolates (n = 17) were found to be ESBL producers.

This is the first community-based study of its own kind that explored the prevalence of antibiotic-resistant commensal E. coli in the children of rural areas of Sikkim as an indication or indicator of the emergence of antibiotic resistance. Antibiotic resistance (AR) has become one of the world’s most pressing public health problems of this era. Unnecessary use of antibiotics without prescription for treatment of common bacterial infection is considered as one of the leading causes of the emergence of antibiotic resistance in common pathogens. The AR can make easily treatable illness a dangerous infection leading to prolonged sufferings. It can spread to the family members, peer groups, and community through different means. Shared distribution of E. coli in the lower abdomen of human and its susceptible nature to the frequently used antibiotics makes it a good indicator bacterium to study the potential spread and emergence of antibiotic resistance. The current study was designed to assess the prevalence and distribution of antibiotic resistance in E. coli isolated from the stool samples of the healthy children of Sikkim, a northeastern state of India. The results were correspondingly correlated with the demographic data to ascertain the effect of community structure on antibiotic resistance pattern of commensal E. coli.

The current study identified a high prevalence of antibiotic-resistant commensal E. coli in children of rural areas of Sikkim, a state in Northeastern India. The antibiotics resistance pattern was evaluated for individual antibiotics and also for the combination of two to three classes of antibiotics. There was a significant level of correlation between the prevalence of antibiotic resistance in commensal E. coli isolates from the children and the demographic variables like mother’s education, type of family and the access and use of antibiotics. However, the prevalence of antibiotic resistance in E. coli isolates did not display any association with child’s gender. The recovery of a significantly high number of ADR and MDR isolates from the children of the region warrants an immediate need for the commitment to ensure the rational use of antibiotics as much as possible. This is the first report from hills of the eastern Himalayan region regarding the antibiotic resistance profile of gut E. coli isolates from children. The study suggests looming threat of the antibiotic-resistant pathogens to the area and mandates immediate counteractive measures including educating the community about the proper uses of antibiotics and appropriate hygiene habits to tackle the growing problem. This study warrants further investigation into the problem encompassing broader adjoining areas of South East Asia that share the geography and have similar livelihood practices to design a comprehensive strategy for the containment of the problem in the region.




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