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dc.contributor.authorIngle, Danielle J.
dc.contributor.authorLevine, Myron M.
dc.contributor.authorKotloff, Karen L.
dc.creatorIngle, D.
dc.date.accessioned2019-07-03T19:35:15Z
dc.date.available2019-07-03T19:35:15Z
dc.date.issued2018-09-01
dc.identifier.urihttps://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85052381939&origin=inward
dc.identifier.urihttp://hdl.handle.net/10713/9858
dc.description.abstractThe dynamics of antimicrobial resistance (AMR) in developing countries are poorly understood, especially in community settings, due to a sparsity of data on AMR prevalence and genetics. We used a combination of phenotyping, genomics and antimicrobial usage data to investigate patterns of AMR amongst atypical enteropathogenic Escherichia coli (aEPEC) strains isolated from children younger than five years old in seven developing countries (four in sub-Saharan Africa and three in South Asia) over a three-year period. We detected high rates of AMR, with 65% of isolates displaying resistance to three or more drug classes. Whole-genome sequencing revealed a diversity of known genetic mechanisms for AMR that accounted for >95% of phenotypic resistance, with comparable rates amongst aEPEC strains associated with diarrhoea or asymptomatic carriage. Genetic determinants of AMR were associated with the geographic location of isolates, not E. coli lineage, and AMR genes were frequently co-located, potentially enabling the acquisition of multi-drug resistance in a single step. Comparison of AMR with antimicrobial usage data showed that the prevalence of resistance to fluoroquinolones and third-generation cephalosporins was correlated with usage, which was higher in South Asia than in Africa. This study provides much-needed insights into the frequency and mechanisms of AMR in intestinal E. coli in children living in community settings in developing countries. © 2018, The Author(s).en_US
dc.description.sponsorshipThis work was supported by the NHMRC of Australia (Project Grants 1043830 to K.E.H., and 1009296 and 1067428 to R.M.R-B.; Fellowship 1061409 to K.E.H.) and the Bill & Melinda Gates Foundation (Grant 38874 to M.M.L.).en_US
dc.description.urihttps://10.1038/s41564-018-0217-4en_US
dc.language.isoen_USen_US
dc.publisherNature Publishing Groupen_US
dc.relation.ispartofNature Microbiologyen_US
dc.subjectantibiotic resistanceen_US
dc.subject.meshbacterial genomeen_US
dc.subject.meshcontrolled studyen_US
dc.subject.meshdeveloping countryen_US
dc.subject.meshenteropathogenic Escherichia colien_US
dc.subject.meshdiarrheaen_US
dc.subject.meshintestine floraen_US
dc.subject.meshmultidrug resistanceen_US
dc.subject.meshwhole genome sequencingen_US
dc.titleDynamics of antimicrobial resistance in intestinal Escherichia coli from children in community settings in South Asia and sub-Saharan Africaen_US
dc.typeArticleen_US
dc.identifier.doi10.1038/s41564-018-0217-4
dc.identifier.pmid30127495
dc.relation.volume3


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