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. 2023 Jul 5;77(Suppl 1):S75-S81.
doi: 10.1093/cid/ciad283.

High Burden of Intestinal Colonization With Antimicrobial-Resistant Bacteria in Chile: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study

Rafael Araos  1   2   3 , Rachel M Smith  4 , Ashley Styczynski  4 , Felipe Sánchez  5 , Johanna Acevedo  1   6 , Lea Maureira  1 , Catalina Paredes  1 , Maite González  1 , Lina Rivas  1   3 , Maria Spencer-Sandino  1   3 , Anne Peters  1   3 , Ayesha Khan  7 , Dino Sepulveda  1 , Loreto Rojas Wettig  8 , María Luisa Rioseco  8 , Pedro Usedo  9 , Pamela Rojas Soto  10 , Laura Andrea Huidobro  11 , Catterina Ferreccio  2   12 , Benjamin J Park  4 , Eduardo Undurraga  3   13   14   15 , Erika M C D'Agata  16 , Alejandro Jara  17 , Jose M Munita  1   3
Affiliations

High Burden of Intestinal Colonization With Antimicrobial-Resistant Bacteria in Chile: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study

Rafael Araos et al. Clin Infect Dis. .

Abstract

Background: Antimicrobial resistance is a global threat, heavily impacting low- and middle-income countries. This study estimated antimicrobial-resistant gram-negative bacteria (GNB) fecal colonization prevalence in hospitalized and community-dwelling adults in Chile before the coronavirus disease 2019 pandemic.

Methods: From December 2018 to May 2019, we enrolled hospitalized adults in 4 public hospitals and community dwellers from central Chile, who provided fecal specimens and epidemiological information. Samples were plated onto MacConkey agar with ciprofloxacin or ceftazidime added. All recovered morphotypes were identified and characterized according to the following phenotypes: fluoroquinolone-resistant (FQR), extended-spectrum cephalosporin-resistant (ESCR), carbapenem-resistant (CR), or multidrug-resistant (MDR; as per Centers for Disease Control and Prevention criteria) GNB. Categories were not mutually exclusive.

Results: A total of 775 hospitalized adults and 357 community dwellers were enrolled. Among hospitalized subjects, the prevalence of colonization with FQR, ESCR, CR, or MDR-GNB was 46.4% (95% confidence interval [CI], 42.9-50.0), 41.2% (95% CI, 37.7-44.6), 14.5% (95% CI, 12.0-16.9), and 26.3% (95% CI, 23.2-29.4). In the community, the prevalence of FQR, ESCR, CR, and MDR-GNB colonization was 39.5% (95% CI, 34.4-44.6), 28.9% (95% CI, 24.2-33.6), 5.6% (95% CI, 3.2-8.0), and 4.8% (95% CI, 2.6-7.0), respectively.

Conclusions: A high burden of antimicrobial-resistant GNB colonization was observed in this sample of hospitalized and community-dwelling adults, suggesting that the community is a relevant source of antibiotic resistance. Efforts are needed to understand the relatedness between resistant strains circulating in the community and hospitals.

Keywords: Latin America; antimicrobial-resistance; colonization; community; gram-negative.

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Conflict of interest statement

Potential conflicts of interest. Rafael Araos reports funding from the US Centers for Disease Control and Prevention (CDC), China Center for Disease Control, and the Chile Ministry of Science (ANID). He reports consulting for coronavirus disease 2019 (COVID-19) vaccines from Astra Zeneca, Pfizer, and Sinovac; support for attending a meeting about COVID-19 vaccines from Tecnofarma, and helds a position with the COVID-19 external advisory group to the Chile Ministry of Health. Erika MC D'Agata reports receiving a grant for optimizing antimicrobial use in dialysis units (AHRQ R01). José M. Munita reports receiving funding from CDC Broad Agency Announcements (BAA) (FY2018-OADS-01). Dino Sepúlveda reports research funding from the Canadian Institutes of Health (Grant 136927) and The Universidad del Desarrollo, and also reports honoraria for lectures and teaching with the University of Santiago of Chile, Universidad Autonoma de Chile, and World Bank. He also received support for travel and accommodation for attending the LATAM policy forum and an international workshop on HTA. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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