Impact of water chlorination on children’s carriage of antimicrobial resistant bacteria
BACKGROUND: Infant and young child infections are increasingly caused by drug resistant bacteria, which increases risks of morbidity and mortality due to treatment failure. In Bangladesh, more than half of all community-acquired infant bacteria isolates are resistant to second and third generation cephalosporins.
GAP: Drinking water treatment could be a cost-effective intervention to reduce drug resistant bacterial infections among children, yet no previous study has rigorously evaluating the effect of consuming treated water on child carriage of antimicrobial resistant bacteria.
HYPOTHESIS: The study will explore the following two hypotheses: 1) children under five in urban Dhaka, Bangladesh with access to water disinfected by chlorination at the point-of-collection (treatment) relative to children without access (control) will have lower prevalence and diversity of extended spectrum beta-lactamase-producing Enterobactericeae, or ESBL-E, in fecal samples, and 2) chlorinated drinking water will significantly change the microbial diversity in child gut microbiota.
METHODS: Approximately 600 children (from 100 clusters) were enrolled in a randomized controlled trial of chlorinated drinking water in Dhaka, Bangladesh, with half of the children receiving point-of-collection chlorinated water and the other half receiving an active control (Vitamin C). Fecal samples from these two cohorts will be used to compare carriage rates of ESBL-E and other antibiotic resistances; gut microbial diversity between the two groups will also be compared.
IMPACT: The study will be the first to assess the potential of environmental interventions to control ESBL-E carriage rates, and therefore risk of infection, in children using a cluster randomized controlled trial study design. The study will also be the first to assess chlorinated drinking water exposure impacts on microbiota. Both outcomes will provide insight on the potential benefits of environmental control strategies for antimicrobial resistant bacteria.
The research is a collaboration with Dr. Amy J. Pickering (Tufts University, USA), Dr. M. Aminul Islam (icddr,b, Bangladesh), Dr. Stephen P. Luby (Stanford University, USA), Dr. Val Fernandez Lanza (Hospital Universitario Ramón y Cajal, Spain), and Dr. M. Camila Montealegre (Eawag, Switzerland).