Observational studyPLoS medicine2023
Risk factors for extended-spectrum beta-lactamase (ESBL)-producing E. coli carriage among children in a food animal-producing region of Ecuador: A repeated measures observational study.
Observational study in PLoS medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
15 citing papers in PubMed, 13 citations in OpenAlex.
- ESBL and carbapenemase-producing enteric pathogens in animal-origin foods: a one health perspective.Folia microbiologica · 2026Review
- Antimicrobial Resistance Gene Profiles in Integron-Positive and Integron-Negative Third-Generation Cephalosporin-ResistantAntibiotics (Basel, Switzerland) · 2026Article
- Investigating the zoonotic origins of ESBL-producingMicrobiology spectrum · 2026Article
- Genomic Diversity and Extended-SpectrumInternational journal of microbiology · 2026Article
- Environmental exposures associated with the gut microbiome and resistome of pregnant women and children in Northwest Ecuador.Nature communications · 2025Article
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- Article
- Extensive Overlap in Avian and Extraintestinal PathogenicAvian diseases · 2025Article
- Environmental Exposures and the Human Gut Resistome in Northwest Ecuador.medRxiv : the preprint server for health sciences · 2025Article
- Article
- Risk Perception and Psychosocial Factors Influencing Exposure to Antimicrobial Resistance through Environmental Pathways in Malawi.The American journal of tropical medicine and hygiene · 2025Article
- Detection of mobile colistin resistance genesMicrobiology resource announcements · 2024Article
- Detecting Class 1 Integrons and Their Variable Regions inAntibiotics (Basel, Switzerland) · 2024Article
- Leveraging the COVID-19 pandemic as a natural experiment to assess changes in antibiotic use and antibiotic-resistant E. coli carriage in semi-rural Ecuador.Scientific reports · 2023Observational
- Genomic insights into ESBL-producingFrontiers in veterinary science · 2023Article
Corrections and comments
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Authors and funding
12 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundThe spread of antibiotic-resistant bacteria may be driven by human-animal-environment interactions, especially in regions with limited restrictions on antibiotic use, widespread food animal production, and free-roaming domestic animals. In this study, we aimed to identify risk factors related to commercial food animal production, small-scale or "backyard" food animal production, domestic animal ownership, and practices related to animal handling, waste disposal, and antibiotic use in Ecuadorian communities. METHODS AND
findingsWe conducted a repeated measures study from 2018 to 2021 in 7 semirural parishes of Quito, Ecuador to identify determinants of third-generation cephalosporin-resistant E. coli (3GCR-EC) and extended-spectrum beta-lactamase E. coli (ESBL-EC) in children. We collected 1,699 fecal samples from 600 children and 1,871 domestic animal fecal samples from 376 of the same households at up to 5 time points per household over the 3-year study period. We used multivariable log-binomial regression models to estimate relative risks (RR) of 3GCR-EC and ESBL-EC carriage, adjusting for child sex and age, caregiver education, household wealth, and recent child antibiotic use. Risk factors for 3GCR-EC included living within 5 km of more than 5 commercial food animal operations (RR: 1.26; 95% confidence interval (CI): 1.10, 1.45; p-value: 0.001), household pig ownership (RR: 1.23; 95% CI: 1.02, 1.48; p-value: 0.030) and child pet contact (RR: 1.23; 95% CI: 1.09, 1.39; p-value: 0.001). Risk factors for ESBL-EC were dog ownership (RR: 1.35; 95% CI: 1.00, 1.83; p-value: 0.053), child pet contact (RR: 1.54; 95% CI: 1.10, 2.16; p-value: 0.012), and placing animal feces on household land/crops (RR: 1.63; 95% CI: 1.09, 2.46; p-value: 0.019). The primary limitations of this study are the use of proxy and self-reported exposure measures and the use of a single beta-lactamase drug (ceftazidime with clavulanic acid) in combination disk diffusion tests for ESBL confirmation, potentially underestimating phenotypic ESBL production among cephalosporin-resistant E. coli isolates. To improve ESBL determination, it is recommended to use 2 combination disk diffusion tests (ceftazidime with clavulanic acid and cefotaxime with clavulanic acid) for ESBL confirmatory testing. Future studies should also characterize transmission pathways by assessing antibiotic resistance in commercial food animals and environmental reservoirs.
conclusionsIn this study, we observed an increase in enteric colonization of antibiotic-resistant bacteria among children with exposures to domestic animals and their waste in the household environment and children living in areas with a higher density of commercial food animal production operations.
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