ArticleAntimicrobial resistance and infection control2021
Carriage of antimicrobial-resistant bacteria in a high-density informal settlement in Kenya is associated with environmental risk-factors.
Article in Antimicrobial resistance and infection control, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
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Who cites it
23 citing papers in PubMed, 35 citations in OpenAlex.
- Frequency of Antimicrobial Resistance Among Fecal Bacteria Pathogens in an Informal Settlement in Nairobi, Kenya, 2018 to 2020.Microorganisms · 2026Article
- Review of risk factors and prediction models for multidrug-resistant bacterial pulmonary infections in patients with chronic obstructive pulmonary disease.The Journal of international medical research · 2026Review
- Burden of Antibiotic Resistance in Hospitalized Children in Kenya: Associations with Mortality, Hospital Stay, and Treatment Costs.The American journal of tropical medicine and hygiene · 2026Article
- Antibiotics and priority effects on colonizing resistant Escherichia coli strain assemblages in a community setting.PloS one · 2026Article
- Genomic diversity of diarrheagenic multidrug-resistant Escherichia coli across asymptomatic children and livestock in Nairobi, Kenya.PLOS global public health · 2026Article
- Antimicrobial resistance, equity and justice in low- and middle-income countries: an intersectional critical interpretive synthesis.Nature communications · 2025Article
- Mapping the AMR Infection Landscape in Bihar: Implications for Strengthening Policy and Clinical Practice.Antibiotics (Basel, Switzerland) · 2025Article
- Risk factors associated with community colonization of extended-spectrum cephalosporin-resistant Enterobacterales from an antibiotic resistance in communities and hospitals (ARCH) study, Guatemala.Scientific reports · 2025Article
- The unseen climate health risks of antimicrobial resistance in urban informal settlements.Nature medicine · 2025Article
- Behavioral and Socio-Economic Determinants of Antimicrobial Resistance in Sub-Saharan Africa: A Systematic Review.Infection and drug resistance · 2025Review
- A Just Transition for Antimicrobial Resistance: The Need for More Forms and a Broader Scope of Justice.Public humanities · 2025Article
- Antibiotic prescribing patterns and carriage of antibiotic-resistantJAC-antimicrobial resistance · 2024Article
- Social and ecological determinants of antimicrobial resistance in Africa: a systematic review of epidemiological evidence.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2024Review
- Long-term antibiotic exposure landscapes and resistant Escherichia coli colonization in a densely populated setting.PloS one · 2024Article
- Risk Factors, Temporal Dependence, and Seasonality of Human Extended-Spectrum β-Lactamases-Producing Escherichia coli and Klebsiella pneumoniae Colonization in Malawi: A Longitudinal Model-Based Approach.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- Risk Factors for Colonization With Multidrug-Resistant Bacteria in Urban and Rural Communities in Kenya: An Antimicrobial Resistance in Communities and Hospitals (ARCH) Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- Drivers of household antibiotic use in urban informal settlements in Northern Ghana: Implications for antimicrobial resistance control.Health science reports · 2023Article
- Investigating One Health risks for human colonisation with extended spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Malawian households: a longitudinal cohort study.The Lancet. Microbe · 2023Article
- ESBL-Positive Enterobacteriaceae from Dogs of Santiago and Boa Vista Islands, Cape Verde: A Public Health Concern.Antibiotics (Basel, Switzerland) · 2023Article
- Carriage of Antibiotic Resistant Bacteria and Associated Factors Among Food Handlers in Tamale Metropolis, Ghana: Implications for Food Safety.Microbiology insights · 2023Article
Corrections and comments
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Authors and funding
13 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe relationship between antibiotic use and antimicrobial resistance varies with cultural, socio-economic, and environmental factors. We examined these relationships in Kibera, an informal settlement in Nairobi-Kenya, characterized by high population density, high burden of respiratory disease and diarrhea.
methodsTwo-hundred households were enrolled in a 5-month longitudinal study. One adult (≥ 18 years) and one child (≤ 5 years) participated per household. Biweekly interviews (n = 1516) that included questions on water, sanitation, hygiene, and antibiotic use in the previous two weeks were conducted, and 2341 stool, 2843 hand swabs and 1490 drinking water samples collected. Presumptive E. coli (n = 34,042) were isolated and tested for susceptibility to nine antibiotics.
resultsEighty percent of presumptive E. coli were resistant to ≥ 3 antibiotic classes. Stool isolates were resistant to trimethoprim (mean: 81%), sulfamethoxazole (80%), ampicillin (68%), streptomycin (60%) and tetracycline (55%). Ninety-seven households reported using an antibiotic in at least one visit over the study period for a total of 144 episodes and 190 antibiotic doses. Enrolled children had five times the number of episodes reported by enrolled adults (96 vs. 19). Multivariable linear mixed-effects models indicated that children eating soil from the household yard and the presence of informal hand-washing stations were associated with increased numbers of antimicrobial-resistant bacteria (counts increasing by 0·27-0·80 log
conclusionsAntibiotic use provided little explanatory power for the prevalence of antimicrobial resistance. Transmission of resistant bacteria in this setting through unsanitary living conditions likely overwhelms incremental changes in antibiotic use. Under such circumstances, sanitation, hygiene, and disease transmission are the limiting factors for reducing the prevalence of resistant bacteria.
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