Risk Factors for Colonization With Antibiotic-Resistant Bacteria Among Community Adults in Bangladesh: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study
Gemma Parra, Syeda Mah-E-Muneer, Dilruba Ahmed, Kamal Hossain, Md Zakiul Hassan, Mahmudur Rahman, Debashis Sen, Palash Mozumder, Aninda Rahman, Gazi Md Salahuddin Mamun, Garrett Mahon, Rachel M Smith, Ashley Styczynski, Fahmida ChowdhuryAbstract
Background
Antimicrobial resistance (AR) is a growing global health threat that is increasingly affecting communities. This study investigated risk factors for colonization with antibiotic-resistant bacteria (ARB) among asymptomatic community participants in Bangladesh, where a previous study found 78% colonized with extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE), 9% with carbapenem-resistant Enterobacterales (CRE), and 22% with methicillin-resistant Staphylococcus aureus (MRSA).
Method
Adults from an urban community in Dhaka completed surveys on demographic characteristics and individual and household exposures. We used bivariate analyses, random forest variable selection, and multivariable logistic regression to identify factors associated with ESCrE, CRE, and MRSA colonization.
Results
Among 768 participants, ESCrE colonization was associated with using a public tap rather than piped household water (adjusted odds ratio [aOR], 11.24; 95% CI, 1.28, 98.6). Public tap use was also associated with higher odds of MRSA colonization (aOR, 2.38; 95% CI, 1.37, 4.16), as was bottled/jarred water (aOR, 5.5; 95% CI, 2.62, 11.55). Milk consumption was found to be inversely associated with MRSA colonization (aOR, 0.71; 95% CI, .51, .97). Although public tap use and limited household handwashing facilities were associated with CRE colonization in bivariate analyses, neither was maintained in the final model.
Conclusions
In this study, water, sanitation, and hygiene (WASH)-related factors were associated with ARB colonization in the community; however, estimates were imprecise and not robust to adjustment. These findings suggest that WASH-related exposures, such as drinking water source, may reflect broader structural determinants of risk. Better understanding of community risk factors could inform targeted interventions in high-burden settings.