Assessing effects of pneumococcal vaccination (PCV13) and rotavirus vaccination (RV) on colonization with extended-spectrum cephalosporin-resistant enterobacterales (ESCrE) in guatemalan children

Abstract

Background: We aimed to determine if vaccination against rotavirus (RV) or pneumococcus (PCV13) is associated with reduced colonization with extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) in children (<15 years) living in Guatemala.

Methods: Questionnaire information, vaccine records, and stool samples were collected from enrolled participants. Specimens were plated onto selective media with antibiotic susceptibility confirmed using a VITEK®2. We employed an instrumental variables approach with maximum likelihood for a system of three nested probit regression equations for binary outcomes of RV or PCV13 vaccination, diarrhea or clinic visits, and ESCrE colonization.

Results: Participants (n = 406) ranged from 0 to 14 years old, 123 (30.3 %) were 0-2 years old, 103 (25.4 %) were 3-5 years old, and 180 (44.3 %) were 6-14 years old. PCV13 vaccination had indirect negative effects on ESCrE colonization (-0.092, P < 0.01) mediated through clinic visits (-0.461, P < 0.01), while antibiotic use had a direct positive effect on clinic visits (0.226, P < 0.01), but no significant effects on ESCrE colonization. Effects of RV on ESCrE colonization were inconclusive likely due to the limited sample size of RV-unvaccinated children. Protective effects of yogurt consumption on ESCrE colonization (-0.064, P < 0.01; -0.062, P < 0.01) and positive direct effects of land used for agriculture (0.232, P < 0.01; 0.224, P 〈001) were detected in both RV and PCV13 models, respectively. Report of diarrhea in the past 30 days had a direct positive effect on colonization (0.731, P < 0.01) in the RV model, and indirect positive effects on ESCrE colonization (0.090, P < 0.01) in the PCV13 model.

Interpretation: Vaccination for pneumococcal disease was associated with a reduction in colonization with ESCrE bacteria. Antibiotic use did not contribute directly or indirectly to ESCrE colonization. These findings should be confirmed through studies designed to collect clinical outcomes data. Findings from this and other studies suggest that ESCrE colonization is mediated by a complex interplay of factors.

Keywords: Extended-spectrum cephalosporin-resistant Enterobacterales; Guatemala; PCV13; RV; colonization; communities.