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One health approach unravels worrying antimicrobial resistance patterns: A cross-sectional study in Kisii, Kenya

Year: 2025

Type: article

Abstract: BACKGROUND: Antimicrobial resistance (AMR) is a major public health challenge, particularly in Sub-Saharan Africa, where diagnostic and surveillance capacities are limited. Enterobacterales significantly contribute to AMR, with environmental reservoirs facilitating transmission between humans, animals, and the environment. METHODS: This study investigated the prevalence and antimicrobial susceptibility of selected Enterobacterales in human, water, animal feces, and soil samples in Kenya. A cross-sectional study including 200 patients with gastrointestinal symptoms was conducted at Kisii Teaching and Referral Hospital and surrounding areas. AMR testing was performed using the disk diffusion method. RESULTS: A total of 365 samples were collected: 200 human and 55 each of water, animal feces, and soil specimens from the homesteads of patients with resistant isolates. 343 isolates were obtained (Escherichia coli: 280/343 [81.6%], Salmonella spp.: 28/343 [8.2%], Klebsiella spp.: 25/343 [7.3%], Shigella spp.: 10/343 [2.9%]). A significant proportion of isolates exhibited AMR, particularly to piperacillin-tazobactam (up to 87%) and ampicillin (up to 79%). Resistance to piperacillin-tazobactam in E. coli was the highest, observed in humans (100/139, 71.9%), water (42/49, 85.7%), animal feces (9/46, 19.6%), and soil (33/46, 71.7%). Almost half (45%) of the human isolates showed ESBL production or resistance to imipenem, with water, animal feces, and soil samples, revealing similar resistance patterns. Resistance to chloramphenicol (71.7% vs 20.1%; p < 0.001) and third-generation cephalosporins were higher among animal and environmental isolates (animal feces: cefotaxime - 25/46, 54.3%; ceftazidime - 27/46, 58.7%) as compared to human isolates (cefotaxime - 40/139, 28.8%; ceftazidime - 28/139, 20.1%) (p < 0.001). In human isolates, the most prevalent genes were blaTEM (53/187, 28.3%), blaOXA-48 (43/187, 23.0%), blaSHV (32/187, 17.1%), and blaCTXM-15 (41/187, 21.9%); in animal isolates, blaCTXM-8 (11/55, 20.0%), blaVIM (8/55, 14.5%), and blaTEM (8/55, 14.5%) were most detected; while in soil and water isolates, blaCTXM-8 was the most common (10.9% and 9.1% respectively). CONCLUSION: Shared resistance patterns across human, animal, and environmental samples highlight interconnected AMR pathways. These findings reinforce the need for a One Health approach through integrated AMR surveillance and interventions.

Source: PLoS ONE

DOI: 10.1371/journal.pone.0331389