Distribution of Antimicrobial Resistance Indicators in Wastewater and Demographic Risk Factors Across Diverse Atlanta Metropolitan Communities Público
Sheikhzadeh, Caroline Homa (Spring 2023)
Abstract
Background Antimicrobial-resistant (AMR) bacteria are responsible for 2.8 million infections and 35,900 deaths annually in the U.S. alone, with alarming growth rates of global AMR prevalence. The relationship between social determinants of health and AMR prevalence is still understudied, and there is a critical need to establish standards for AMR quantification and risk factor surveillance. This paper aims to explore the use of wastewater surveillance to assess relationships between increased AMR prevalence and hypothesized risk factors across diverse communities in Atlanta.
Methods In December 2022, wastewater samples were collected from seven wastewater treatment plants (WWTPs) in metropolitan Atlanta. Samples were cultured for third-generation-cephalosporins-resistant (3GC) and carbapenem-resistant (CR) E. coli and Klebsiella pneumoniae, and fluoroquinolone (FQ)-resistant Enterobacterales. The U.S. Census Bureau’s 2020 American Community Survey was used to explore age, race, sex, median household income, poverty, and uninsured variables as they relate to AMR prevalence in communities captured by WWTPs. Outcomes were analyzed using simple and multiple linear regression (SLR, MLR) models. The reduced MLR model included female, foreign-born, uninsured, and age under 5 as covariates.
Results In the MLR, we found a significant relationship between FQ-resistant Enterbacterales and foreign-born status (0.21-CFU/100mL increase with 1% increases in foreign-born status). The SLR models found significant relationships between both CR E. coli and FQ-resistant Enterobacterales and population over 75 (52 and 2.4-CFU/100mL decrease, respectively, with 1% increases in population 75 and older). There was also a significant relationship between CR E. coli and Non-Hispanic (NH) Asians (5.8-CFU/100mL increase in CR E. coli with 1% increases in NH Asians).
Conclusion Increases in concentrations of AMR bacteria cultured from wastewater were related to increases in percentages of foreign-born and NH Asians and decreases in percentage 75 and older. While these are the only significant relationships, further analysis with larger sample sizes could provide more insight into potential relationships between AMR prevalence and other risk factors. These results support the need for standardized methods of AMR surveillance and to better understand risk assessment frameworks for targeted resource allocation in hopes to slow global AMR prevalence rates.
Table of Contents
Chapter 1 INTRODUCTION……………………………..…………………………..….…… 1
Chapter 2 METHODOLOGY………………………….……………………………….………12
Chapter 3 RESULTS & FINDINGS………………...………………………………...………27
Chapter 4 DISCUSSION…………………………………………….………………….………43
APPENDIX A: ACKNOWLEDGEMENTS………………………….…………………..…… 52
REFERENCES……………………………………………………...………………….…...……53
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