Epidemiology of Extended-spectrum beta-lactamase-producing Escherichia coli at the human-animal-environment interface in Wakiso district, Uganda

BackgroundExtended-spectrum beta-lactamase-producing Escherichia coli (ESBL-PE) represents a significant global public health concern. Much as humans, animals and environments harbor ESBL-PE, its epidemiology in Uganda is still not well understood. This study explains the epidemiology of ESBL-PE using the one health approach in selected farming households in Wakiso district, central Uganda. MethodologyEnvironmental, human, and animal samples were collected from 104 households. Additional data were obtained using observation checklists and through interviews with household members using a semi-structured questionnaire. Surface swabs, soil, water, human and animal fecal samples were introduced onto ESBL chromogenic agar. The isolates were identified using biochemical tests and double-disk synergy tests. To assess associations, prevalence ratios (PRs) were computed using a generalized linear model (GLM) analysis with modified Poisson and a log link with robust standard errors in R software. ResultsA total of 82.7% (86/104) households had at least one positive ESBL-PE isolate. The overall prevalence of ESBL-PE at the human-animal-environment interface was approximately 25.0% (95% CI: 22.7-28.3). Specifically, animals, environment and humans had an ESBL-PE prevalence of 35.4%, 5.8%, and 45.4% respectively. Having visitors (adj PR= 1.19, 95% CI: 1.04-1.36), utilizing veterinary services (adj PR= 1.39, 95% CI: 1.20-1.61) and using animal waste for gardening (adj PR= 1.29, 95% CI: 1.05-1.60) were positively associated with ESBL-PE contamination. However, covering the drinking water container with a lid (adj PR= 0.84 95% CI: 0.73-0.96) was associated with absence of ESBL-PE. ConclusionThere is wider dissemination of ESBL-PE in the environment, humans, and animals, indicating poor infection prevention and control (IPC) measures in the area. Improved collaborative one health mitigation strategies such as safe water chain, farm biosecurity, household and facility-based IPC measures are recommended to reduce the burden of antimicrobial resistance at community level.