The role of drinking water as a source of transmission of ...
The role of drinking water as a source of transmission of antimicrobial resistant Escherichia coli Brenda L. Coleman, Allison McGeer, Marina Salvadori, Ian Johnson, Iris Gutmanis, Sue Bondy, Norm Neuman, Marie Louis, Scott McEwen, Fran Jamieson, & Rebecca Irwin Antimicrobial Resistance What is it? Why do we care? How does it occur? Selective pressure Transmission Escherichia coli Human colonization
Human infection Water as a vehicle for transmission E. coli indicator of contamination Private drinking water 10-50% of Canadian households 30-50% test water 2-20% contaminated with E. coli Objectives 1. Measure the proportion of E. coli positive water samples that are antimicrobial resistant (AR) 2. Measure the prevalence of human carriage of AR E. coli 3. Determine whether the use of water contaminated with AR E. coli is associated with human carriage
Sampling Public health labs (Water samples) Standard testing for bacterial contamination at participating laboratories E. coli - positive No bacterial contamination Surveillance (Water samples) E. coli susceptibility tested sample Resistant
Case-control (Households) Eligible & non-replicate households Household questionnaire Case Cross-sectional (Individuals) Susceptible Control A
Control B Eligible individuals Personal questionnaire & rectal swab Resistant Susceptible Water samples 340,009 tested 15,238 E. coli (4.5%) 6,492 susceptibility tested 645 resistant (9.9%)
Proportion of E. coli positive w ater sam ples that w ere antim icrobial resistant Ontario May 2005-Septem ber 2006 12% 10% 6% 4% One or more Sulphonamide Aminoglycoside Fluoroquinolone
Proportion of E. coli- positive w ater sam ples and proportion of antim icrobial resistant E. coli- positive isolates Ontario, May 1, 2005 - Septem ber 30, 2006 25% E. coli Resistant 15% 10% Peterborough Kingston Orillia Toronto
Ottawa London 0% ONTARIO 5% Hamilton Per 100 submitted samples 20% Human samples
1,710 households eligible 831 household questionnaires 655 households 985 personal questionnaires 488 households 699 rectal swabs Households & Subjects 488 households 108 with AR E. coli water source
69 with untreated AR E. coli 699 subjects 12 to 87 years old Males = females 433 (62%) used tap water only 376 (54%) travelled outside Canada 185 (27%) had direct livestock contact 85 (12%) used antibiotic Chloramphenicol Tetracycline Sulphonamide Fluoroquinolone Aminoglycoside
Ampicillin Multi-drug One or more Proportion of rectal swabs with AR E. coli Ontario, 2005-2007 50% 40% 30% 20%
10% 0% Theorized relationship between human carriage & consumption of antimicrobial resistant E. coli Potential effect modifier: Bottled water Primary predictor: Water used Outcome: Carriage of antimicrobial resistant E. coli Potential confounders:
Age Antibiotic use Sex Hospitalization Household education Child in day care Household income Household size Laboratory region Contact with livestock Mode of data collection Farming property Days between water sample Contact with dog/cat & interview Contact with raw meat Travel Final multivariable model Predictor
RR 95% Conf. interval Water used (contaminated & not treated) 1.4 1.1, 1.7 Travel outside Canada 1.3 1.1, 1.6 Contact with cattle
1.3 1.0, 1.5 Sex (male) 1.2 1.0, 1.5 Limitations Convenience sample Age of subjects
Lack of exposure dose/treatment of water Causation Conclusions Private drinking water sources are contaminated with AR E. coli Relatively high prevalence of AR E. coli carriage in non-institutionalized residents Carriage of AR E. coli is associated with the use of contaminated water
Packed tower air stripping is commonly used to remove volatile contaminates ( e.g., tetrachloroethylene, trichloroethylene, benzene, ammonia) from contaminated waters. Increasingly, it is being applied to the renovation of groundwaters that have become contaminated with volatile organic carbon ...
19 The Cardiovascular System: Blood Vessels Anatomy Blood Vessels Blood is carried in a closed system of vessels that begins and ends at the heart The three major types of vessels are arteries, capillaries, and veins Arteries carry blood away...
TRACTOR SAFETY SAFELY WORKING WITH AND AROUND TRACTORS Introduction The following safety module is intended to be used as a refresher safety awareness session and is in no way to be used as a substitute for job training nor proper...
Instructions: Select the correct verb to complete each sentence.. VOCABULARY SPOTLIGHT 15 Minutes Sample Sentences. Trying to be . objective, I considered only facts and statistics when selecting my fantasy football team. ... Qualm. Explanation of ICI Strategy.
Name That Metal! Presentation for Name That Metal! Activity> TeachEngineering.org. copper. ... in 9000 BC in the Middle East. Italians used copper lumps as money in the 6th-3rd centuries BC. History of Copper. Copper wire was used as an insulator...
This research will use a qualitative case study methodology, and consult decolonising methodologies throughout the research. Research design: The proposed research will follow a qualitative case study design. Involving a . selection of case studies .
INFORMAZIONE AL PAZIENTE Illustrare al paziente lo scopo e il funzionamento del presidio. Dare le brevi istruzioni che deve conoscere per preservare il buon funzionamento dello stesso. "DARE PAROLE AL DOLORE RESTA UN IMPERATIVO E UN DOVERE A CUI NON...
Ready to download the document? Go ahead and hit continue!