Sanitation in urban areas may limit the spread of antimicrobial resistance via flies

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  • Capone D
    • Other Affiliation: Department of Environmental and Occupational Health, Indiana University, Bloomington, IN, United States
  • Cumming O
    • Other Affiliation: Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
  • Flemister A
    • Other Affiliation: Roy Blunt NextGen Precision Health, University of Missouri, Columbia, MO, United States
  • Ilevbare V
    • Affiliation: College of Arts and Sciences, Department of Biology
  • Irish S.R
    • Other Affiliation: Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
  • Keenum I
    • Other Affiliation: Department of Civil, Environmental and Geospatial Engineering, Michigan Technological University, Houghton, MI, United States
  • Knee J
    • Other Affiliation: Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
  • Nala R
    • Other Affiliation: Ministério da Saúde de Moçambique, Instituto Nacional de Saúde, Maputo, Mozambique
  • Brown J
    • Affiliation: Gillings School of Global Public Health, Department of Environmental Sciences and Engineering
Abstract
  • Synanthropic filth flies are common where sanitation is poor and fecal wastes are accessible to them. These flies have been proposed as mechanical vectors for the localized transport of fecal microbes including antimicrobial resistant (AMR) organisms and associated antimicrobial resistance genes (ARGs), increasing exposure risks. We evaluated whether an onsite sanitation intervention in Maputo, Mozambique reduced the concentration of enteric bacteria and the frequency of detection of ARGs carried by flies collected in household compounds of low-income neighborhoods. Additionally, we assessed the phenotypic resistance profile of Enterobacteriaceae isolates recovered from flies during the pre-intervention phase. After fly enumeration at study compounds, quantitative polymerase chain reaction was used to quantify an enteric 16S rRNA gene (i.e., specific to a cluster of phylotypes corresponding to 5% of the human fecal microflora), 28 ARGs, and Kirby Bauer Disk Diffusion of Enterobacteriaceae isolates was utilized to assess resistance to eleven clinically relevant antibiotics. The intervention was associated with a 1.5 log10 reduction (95% confidence interval: -0.73, -2.3) in the concentration of the enteric 16S gene and a 31% reduction (adjusted prevalence ratio = 0.69, [0.52, 0.92]) in the mean number of ARGs per fly compared to a control group with poor sanitation. This protective effect was consistent across the six ARG classes that we detected. Enterobacteriaceae isolates–only from the pre-intervention phase–were resistant to a mean of 3.4 antibiotics out of the eleven assessed. Improving onsite sanitation infrastructure in low-income informal settlements may help reduce fly-mediated transmission of enteric bacteria and the ARGs carried by them.
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  • Article
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  • In Copyright
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  • Attribution 4.0 International
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  • PLoS ONE
Journal volume
  • 19
Journal issue
  • 3-Mar
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  • English
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  • 1932-6203
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  • Public Library of Science

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