Antibiotic susceptibility among non-clinical Escherichia coli as a marker of antibiotic pressure in Peru (2009-2019): one health approach

Abstract

Objective: Antimicrobial resistance is an increasing health problem worldwide with serious implications in global health. The overuse and misuse of antimicrobials has resulted in the spread of antimicrobial-resistant microorganisms in humans, animals and the environment. Surveillance of antimicrobial resistance provides important information contributing to understanding dissemination within these environments. These data are often unavailable in low- and middle-income countries, such as Peru. This review aimed to determine the levels of antimicrobial resistance in non-clinical Escherichia coli beyond the clinical setting in Peru.

Methods: We searched 2009-2019 literature in PUBMED, Google Scholar and local repositories.

Results: Thirty manuscripts including human, food, environmental, livestock, pets and/or wild animals' samples were found. The analysis showed high resistance levels to a variety of antimicrobial agents, with >90% of resistance for streptomycin and non-extended-spectrum cephalosporin in livestock and food. High levels of rifamycin resistance were also found in non-clinical samples from humans. In pets, resistance levels of 70->90% were detected for quinolones tetracycline and non-extended spectrum cephalosporins. The results suggest higher levels of antimicrobial resistance in captive than in free-ranging wild-animals. Finally, among environmental samples, 50-70% of resistance to non-extended-spectrum cephalosporin and streptomycin was found.

Conclusions: High levels of resistance, especially related to old antibacterial agents, such as streptomycin, 1st and 2nd generation cephalosporins, tetracyclines or first-generation quinolones were detected. Antimicrobial use and control measures are needed with a One Health approach to identify the main drivers of antimicrobial resistance due to interconnected human, animal and environmental habitats.

Keywords: Antimicrobial resistance; Escherichia coli; One health.

Figure 1

Geographical origin of the studies. The primary politic subdivision of Peru is in Departments. Those Departments from which were analyzed samples, are highlighted in color, and the name has been added in the map. Note that these marks does no preclude the authorship of authors based in these regions. Similarly, the symbols in the map only refers to Department, no to specific areas within each department. Note that in the map Callao, a special Peruvian administrative region, with range equivalent to Department, is included within Lima department. In fact, Callao is surrounded by the sea and the metropolitan area of Lima city.

Figure 2

Overall data of antimicrobial resistance in Escherichia coli (2009–2019). AF: Antimicrobial agents' families; N: Number; AMG: Aminoglycosides (amikacin. gentamicin, kanamycin neomycin, tobramycin) excepting streptomycin; AMG (S): Aminoglycosides (only streptomycin); CBP: Carbapenems (ertapenem, imipenem, meropenem); nesCph: non extended-spectrum cephalosporins (cefazolin, cefalotin; cefalexin; cefuroxime); ESC: Extended-spectrum cephalosporins (ceftazidime, cefotaxime, cefepime, ceftriaxone); CPH: Cefamicins (cefoxitin, oxacillin); Q/FQ: Quinolones (nalidixic acid) and Fluoroquinolones (ciprofloxacin, norfloxacin, enrofloxacin); FPI: Folate pathway inhibitors (cotrimoxazole, sulfamethoxazole); MB: Monobactams (aztreonam); PEN: Penicillins (ampicillin, amoxicillin); PEN + I: Penicillins plus inhibitors of β-Lactamases (amoxicillin plus clavulanic acid, sulperazone); PHE: Phenicols (chloramphenicol, florfenicol); POL: Polymyxins (colistin); PHO: Phosphonic acids (fosfomycin); TET: Tetracyclines (tetracycline, doxycycline, oxytetracycline); NIT: Nitrofurans (furazolidone; nitrofurantoin); RF: Rifamycins (rifaximin); MCR: Macrolides (azithromycin); N.D.: No data. The numbers represent the minimum and the maximum percentage of resistance to any of the tested antibacterial agents belonging to each family. The mean values of resistance are represented by colors; to establish this value the maximum mean value of any of the antimicrobial agents belonging to a specific family was considered. Note that these approaches result in a sub estimation of the real levels of resistance to antibacterial agent families. ^a Following the classification of Magiorakos et al [119]. Families not considered by Magiorakos et al. were reported following standard schemes. ^b Overall number of isolates included in each group. Note that not all isolates were tested for all antimicrobial agents. ^c Maximum value inferred from prevalence of ESBL reported by Ruiz-Roldán et al. [47]. ^d Resistance to quinolones is a risk factor for the development of resistance and therapeutic failure when using fluoroquinolones [97].