Fecal Carriage Rate of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae as a Proxy Composite Indicator of Antimicrobial Resistance in a Community in Thailand

Visanu Thamlikitkul; Teerawit Tangkoskul; Chakkraphong Seenama

doi:10.1093/ofid/ofz425

Fecal Carriage Rate of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae as a Proxy Composite Indicator of Antimicrobial Resistance in a Community in Thailand

Open Forum Infect Dis. 2019 Sep 30;6(10):ofz425. doi: 10.1093/ofid/ofz425. eCollection 2019 Oct.

Authors

Visanu Thamlikitkul¹, Teerawit Tangkoskul¹, Chakkraphong Seenama¹

Affiliation

¹ Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Abstract

Background: Increasing awareness of and understanding about antimicrobial resistance (AMR), promoting changes in behavior, and monitoring of AMR in the community are challenging, as AMR is associated with many contributing factors that are difficult to assess individually. This study aimed to determine the effectiveness of a community-based AMR campaign for improving awareness, understanding, and behavior relating to antibiotic use and AMR in Thailand and to assess if fecal carriage of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae could be a proxy composite indicator of AMR in the community.

Methods: This study was conducted in 4 communities that are home to approximately 400 000 people. A self-administered questionnaire on awareness, understanding, and behavior relating to antibiotic use and AMR was responded to by 20 521 and 19 634 adults before and immediately after the AMR campaign, respectively, at the household level. Fecal samples were collected from 534 adults before the AMR campaign and from 709 adults at 18 months after the AMR campaign to determine presence of ESBL-producing Enterobacteriaceae.

Results: Awareness, understanding, and behavior relating to antibiotic use and AMR, as assessed by a self-administered questionnaire, were significantly improved after the AMR campaign. The fecal carriage rate of ESBL-producing Enterobacteriaceae decreased from 66.5% before to 44.6% after the AMR campaign (P < .01).

Conclusions: Our AMR campaign was effective for improving awareness, understanding, and behavior relating to antibiotic use and AMR among people in the community at the household level, and the prevalence of fecal carriage of ESBL-producing Enterobacteriaceae seemed to be decreased after the AMR campaign. Fecal carriage rate of ESBL-producing Enterobacteriaceae may be a proxy composite indicator of AMR in the community.

Keywords: antimicrobial resistance; community; extended-spectrum beta-lactamase-producing Enterobacteriaceae; fecal carriage; indicator.