Universidad Peruana Cayetano Heredia

Evaluating the relationship between community water and sanitation access and the global burden of antibiotic resistance: an ecological study.

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dc.contributor.author Fuhrmeister, Erica R.
dc.contributor.author Harvey, Abigail P.
dc.contributor.author Nadimpalli, Maya L.
dc.contributor.author Gallandat, Karin
dc.contributor.author Ambelu, Argaw
dc.contributor.author Arnold, Benjamin F.
dc.contributor.author Brown, Joe
dc.contributor.author Cumming, Oliver
dc.contributor.author Earl, Ashlee M.
dc.contributor.author Kang, Gagandeep
dc.contributor.author Kariuki, Samuel
dc.contributor.author Levy, Karen
dc.contributor.author Pinto Jimenez, Chris E.
dc.contributor.author Swarthout, Jenna M.
dc.contributor.author Trueba, Gabriel
dc.contributor.author Tsukayama Cisneros, Pablo
dc.contributor.author Worby, Colin J.
dc.contributor.author Pickering, Amy J.
dc.date.accessioned 2023-07-18T16:18:55Z
dc.date.available 2023-07-18T16:18:55Z
dc.date.issued 2023
dc.identifier.uri https://hdl.handle.net/20.500.12866/13915
dc.description.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 log(10) 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. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartofseries The Lancet. Microbe
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Community Water en_US
dc.subject Sanitation Access en_US
dc.subject Antibiotic Resistance en_US
dc.subject Ecological Study en_US
dc.subject.mesh Recursos Comunitarios
dc.subject.mesh Saneamiento
dc.subject.mesh Farmacorresistencia Microbiana
dc.subject.mesh Estudios Ecológicos
dc.title Evaluating the relationship between community water and sanitation access and the global burden of antibiotic resistance: an ecological study. en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/S2666-5247(23)00137-4
dc.relation.issn 2666-5247


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