ArticleThe Lancet. Microbe2023
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.
Article in The Lancet. Microbe, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 1 of them a synthesis that pooled it.
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Who cites it
39 citing papers in PubMed, 1 synthesis or guideline pooled it, 48 citations in OpenAlex.
- "One Health" perspective on prevalence of co-existing extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae: a comprehensive systematic review and meta-analysis.Annals of clinical microbiology and antimicrobials · 2023Pooled it
- Genomic epidemiology of extended-spectrum beta-lactamase-producingJAC-antimicrobial resistance · 2026Article
- Genomic Surveillance of ESBL-ProducingPathogens (Basel, Switzerland) · 2026Article
- Evaluation of detection performance and cost-effectiveness of IDEXX Colilert-18 and ChromAgar for environmental surveillance of extended-spectrum beta-lactamaseMicrobiology spectrum · 2026Article
- Seasonality and other factors influencing hospital acquisition of multi-drug-resistant Enterobacterales colonisation: a one-year cohort study - Botswana, 2022-2023.Infection prevention in practice · 2026Article
- Emergence of virulent ESBL-producing Escherichia coli in meat with human health implications and control using liposomal cinnamon, oregano, and clove within a One Health framework.Scientific reports · 2026Article
- Factors influencing antibiotic-resistant bacteria colonization among community and hospitalized individuals in Chennai, India: an Antibiotic Resistance in Communities and Hospitals (ARCH) study.Antimicrobial resistance and infection control · 2026Article
- Spread of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) in the community living spaces of patients identified as ESBL-E carriers: impact of the housing density in an African context.Tropical medicine and health · 2026Article
- Animal husbandry and environmental conditions are associated with cefotaxime-resistantmedRxiv : the preprint server for health sciences · 2026Article
- Developing and implementing a family-led infection prevention bundle for hospitalized neonates.Antimicrobial resistance and infection control · 2026Article
- Animal husbandry and environmental conditions are associated with cefotaxime-resistant Escherichia coli in yard soil in peri-urban Malawi.PLOS global public health · 2026Article
- Beyond contact precautions: unmasking environmental and antibiotic drivers of ESBL-E in the ICU.Annals of intensive care · 2026Article
- Transmission of extended spectrum β-lactamase-producing Escherichia coli and antimicrobial resistance gene flow across One Health compartments in eastern Africa: a whole-genome sequence analysis from a prospective cohort study.The Lancet. Microbe · 2026Article
- Antimicrobial susceptibility of Escherichia coli, Klebsiella pneumoniae, and Enterococcus species and the associated risk factors in poultry farms in Blantyre City: a wake-up call to the one health approach.BMC veterinary research · 2025Article
- Quantifying the bystander effect of antimicrobial use on the gut microbiome and resistome in Malawian adults.Nature communications · 2025Article
- Circulation of Salmonella spp. between humans, animals and the environment in animal-owning households in Malawi.Nature communications · 2025Article
- Environmental hazards from pollution of antibiotics and resistance-driving chemicals in an urban river network from Malawi.npj antimicrobials and resistance · 2025Article
- Freshwater snail faecal metagenomes reveal environmental reservoirs of antimicrobial resistance genes across two continents.Microbial genomics · 2025Article
- High diversity of Escherichia coli causing invasive disease in neonates in Malawi poses challenges for O-antigen based vaccine approach.Communications medicine · 2025Article
- Potential pathogens and antimicrobial resistance genes in household environments: a study of soil floors and cow dung in rural Bangladesh.Applied and environmental microbiology · 2025Article
Corrections and comments
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Authors and funding
27 authors at 9 institutions in 3 countries.
Funding
Abstract
backgroundLow-income countries have high morbidity and mortality from drug-resistant infections, especially from enteric bacteria such as Escherichia coli. In these settings, sanitation infrastructure is of variable and often inadequate quality, creating risks of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales transmission. We aimed to describe the prevalence, distribution, and risks of ESBL-producing Enterobacterales colonisation in sub-Saharan Africa using a One Health approach.
methodsBetween April 29, 2019, and Dec 3, 2020, we recruited 300 households in Malawi for this longitudinal cohort study: 100 each in urban, peri-urban, and rural settings. All households underwent a baseline visit and 195 were selected for longitudinal follow-up, comprising up to three additional visits over a 6 month period. Data on human health, antibiotic usage, health-seeking behaviours, structural and behavioural environmental health practices, and animal husbandry were captured alongside human, animal, and environmental samples. Microbiological processing determined the presence of ESBL-producing E coli and Klebsiella pneumoniae, and hierarchical logistic regression was performed to evaluate the risks of human ESBL-producing Enterobacterales colonisation.
findingsA paucity of environmental health infrastructure and materials for safe sanitation was identified across all sites. A total of 11 975 samples were cultured, and ESBL-producing Enterobacterales were isolated from 1190 (41·8%) of 2845 samples of human stool, 290 (29·8%) of 973 samples of animal stool, 339 (66·2%) of 512 samples of river water, and 138 (46·0%) of 300 samples of drain water. Multivariable models illustrated that human ESBL-producing E coli colonisation was associated with the wet season (adjusted odds ratio 1·66, 95% credible interval 1·38-2·00), living in urban areas (2·01, 1·26-3·24), advanced age (1·14, 1·05-1·25), and living in households where animals were observed interacting with food (1·62, 1·17-2·28) or kept inside (1·58, 1·00-2·43). Human ESBL-producing K pneumoniae colonisation was associated with the wet season (2·12, 1·63-2·76).
interpretationThere are extremely high levels of ESBL-producing Enterobacterales colonisation in humans and animals and extensive contamination of the wider environment in southern Malawi. Urbanisation and seasonality are key risks for ESBL-producing Enterobacterales colonisation, probably reflecting environmental drivers. Without adequate efforts to improve environmental health, ESBL-producing Enterobacterales transmission is likely to persist in this setting.
fundingMedical Research Council, National Institute for Health and Care Research, and Wellcome Trust. TRANSLATION: For the Chichewa translation of the abstract see Supplementary Materials section.
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