10.4124/RDM-DEV.LIV.AC.UK/419
antimicrobial resistance
AMR
wildlife
humans
livestock
kenya
environment
urban
University of Liverpool
Background
Antimicrobial resistance (AMR) represents one of the great challenges facing global health security in the modern era. Wildlife species, particularly those that utilise urban environments, are an important but understudied component of AMR epidemiology. This study investigated AMR overlap between sympatric wildlife, humans, livestock and their shared environment across the developing city of Nairobi, Kenya. We use these data to examine the role of urban wildlife in the spread of clinically relevant AMR.
Methods
99 households across Nairobi were randomly selected on the basis of socioeconomic stratification. A detailed survey was administered to household occupants, and samples (n=2102) were collected from the faeces of 75 wildlife species inhabiting household compounds (n=849), 13 livestock species (n=656) and humans (n=333), and from the external environment (n=288). E. coli, our sentinel organism, was cultured, and a single isolate from each sample tested for sensitivity to 13 antibiotics. Diversity of AMR phenotypes were compared between urban wildlife, humans, livestock and the environment, to investigate whether wildlife are a net source for antimicrobial resistance in Nairobi. Generalised linear mixed models were used to determine whether the prevalence of AMR phenotypes and multi-drug resistant (MDR) E. coli carriage in urban wildlife is this linked to variation in ecological traits, such as foraging behaviour, and to determine household-level risk factors for sharing of AMR between humans, wildlife and livestock.
Interpretation
Urban wildlife carry a high burden of clinically relevant AMR-E. coli in Nairobi, exhibiting resistance to drugs considered critically important for human medicine by the World Health Organisation. Identifiable traits of the wildlife contribute to this exposure. However, compared to humans, livestock and the environment, low phenotypic diversity in wildlife is consistent with the hypothesis that they are a net sink rather than source of clinically relevant resistance. Wildlife that interact closely with humans, livestock and their waste within households, are exposed to more AMR phenotypes, and could therefore act as conduits for the dissemination of clinically relevant AMR to the wider environment. These results provide novel insight into the broader epidemiology of AMR in complex urban environments, characteristic of lower-middle income countries.
Dataset
2019
MEDICAL RESEARCH COUNCIL (MRC)
Epidemiology, Ecology and Socio-Economics of Disease Emergence in Nairobi
Epidemiology of Clinically Relevant Antimicrobial Resistance at the Wildlife-Livestock-Human Interface in Nairobi
Kerwin, James
James
Kerwin