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The role of drinking water in the transmission of antimicrobial-resistant E. coli

  • B. L. COLEMAN (a1) (a2), M. I. SALVADORI (a3) (a4), A. J. McGEER (a1) (a2), K. A. SIBLEY (a5), N. F. NEUMANN (a6) (a7), S. J. BONDY (a2), I. A. GUTMANIS (a4) (a8), S. A. McEWEN (a9), M. LAVOIE (a7), D. STRONG (a7), I. JOHNSON (a2) (a10), F. B. JAMIESON (a1) (a2) (a10), M. LOUIE (a5) (a7) and ARO Water Study Group...

To determine whether drinking water contaminated with antimicrobial-resistant E. coli is associated with the carriage of resistant E. coli, selected households sending water samples to Ontario and Alberta laboratories in 2005–2006 were asked to participate in a cross-sectional study. Household members aged ⩾12 years were asked to complete a questionnaire and to submit a rectal swab. In 878 individuals, 41% carried a resistant strain of E. coli and 28% carried a multidrug-resistant strain. The risk of carriage of resistant E. coli was 1·26 times higher for users of water contaminated with resistant E. coli. Other risk factors included international travel [prevalence ratio (PR) 1·33], having a child in nappies (PR 1·33), being male (PR 1·33), and frequent handling of raw red meats (PR 1·10). Protecting private water sources (e.g. by improving systems to test and treat them) may help slow the emergence of antimicrobial resistance in E. coli.

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Corresponding author
*Author for correspondence: Dr B. L. Coleman, Mount Sinai Hospital, 600 University Avenue, Room 210, Toronto, Ontario M5G 1X5, Canada. (Email:
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1.Webber, M, Piddock, L. Quinolone resistance in Escherichia coli. Veterinary Research 2001; 32: 275284.
2.Patterson, JE. Multidrug-resistant Gram-negative pathogens: multiple approaches and measures for prevention. Infection Control and Hospital Epidemiology 2006; 27: 889973.
3.vonBaum, H, Marre, R. Antimicrobial resistance of Escherichia coli and therapeutic implications. International Journal of Medical Microbiology 2005; 295: 503511.
4.Bruinsma, N, et al. Influence of population density on antibiotic resistance. Journal of Antimicrobial Chemotherapy 2003; 51: 385390.
5.Reves, R, et al. Children with trimethoprim- and ampicillin-resistant fecal Escherichia coli in day care centers. Journal of Infectious Diseases 1987; 156: 758762.
6.Prats, G, et al. Cephalosporin-resistant Escherichia coli among summer camp attendees with salmonellosis. Emerging Infectious Diseases 2003; 9: 12731280.
7.Sørum, H, L'Abée-Lund, TM. Antibiotic resistance in food-related bacteria a result of interfering with the global web of bacterial genetics. International Journal of Food Microbiology 2002; 78: 4356.
8.Johnson, JR, et al. Antimicrobial-resistant and extraintestinal pathogenic Escherichia coli in retail foods. Journal of Infectious Diseases 2005; 191: 10401049.
9.Mesa, RJ, et al. Extended-spectrum beta-lactamase-producing Enterobacteriaceae in different environments (humans, food, animal farms, and sewage). Journal of Antimicrobial Chemotherapy 2006; 58: 211215.
10.Government of Canada.Canadian integrated program for antimicrobial resistance surveillance (CIPARS) 2006. Guelph, ON: Public Health Agency of Canada, 2009.
11.Anderson, ME, Sobsey, MD. Detection and occurrence of antimicrobially resistant E. coli in groundwater on or near swine farms in eastern North Carolina. Water Science and Technology 2006; 54: 211218.
12.El-Zanfaly, HT, et al. Incidence of antibiotic resistant bacteria in underground water. Environment International 1988; 14: 391394.
13.Sannes, MR, et al. Predictors of antimicrobial-resistant Escherichia coli in the feces of vegetarians and newly hospitalized adults in Minnesota and Wisconsin. Journal of Infectious Diseases 2008; 197: 430434.
14.van den Braak, N, et al. Dietary habits and gastrointestinal colonization by antibiotic resistant microorganisms. Journal of Antimicrobial Chemotherapy 2001; 47: 495502.
15.Amyes, SG, et al. The incidence of antibiotic resistance in aerobic faecal flora in South India. Journal of Antimicrobial Chemotherapy 1992; 29: 415425.
16.Seidman, JC, et al. Risk factors for antibiotic-resistant E. coli in children in a rural area. Epidemiology and Infection 2009; 137: 879888.
17.Ontario Ministry of the Environment.Protocol of accepted drinking-water testing methods. Toronto, ON: Queen's Printer for Ontario, 2003.
18.Government of Canada.Canadian integrated program for antimicrobial resistance surveillance (CIPARS) 2004. Guelph, ON: Public Health Agency of Canada, 2006.
19.CDC.National antimicrobial resistance monitoring system for enteric bacteria (NARMS): human isolates final report, 2005. Atlanta, GA: US Department of Health and Human Services, CDC, 2008.
20.Health Canada. Water treatment devices for disinfection of drinking water. ( Accessed 30 September 2008.
21.Lumley, T, Kronmal, R, Ma, S. Relative risk regression in medical research: models, contrasts, estimators, and algorithms. University of Washington, 19 July 2006.
22.Corkal, D, Schutzman, W, Hilliard, C. Rural water safety from the source to the on-farm tap. Journal of Toxicology and Environmental Health, Part A 2004; 67: 16191642.
23.U.S. Census Bureau.American housing survey for the United States: 2007, 2008. Current Housing Reports, Series H150/07l.
24.Walia, SK, et al. Self-transmissible antibiotic resistance to ampicillin, streptomycin, and tetracycline found in Escherichia coli isolates from contaminated drinking water. Journal of Environmental Science and Health, Part A: Toxic/Hazardous Substances & Environmental Engineering 2004; A39: 651662.
25.Auld, H, MacIver, D, Klaassen, J. Heavy rainfall and waterborne disease outbreaks: The Walkerton example. Journal of Toxicology and Environmental Health Part A 2004; 67: 18791887.
26.Murray, BE, et al. Emergence of resistant fecal Escherichia coli in travelers not taking prophylactic antimicrobial agents. Antimicrobial Agents and Chemotherapy 1990; 34: 515518.
27.Bonten, M, et al. The role of ‘colonization pressure’ in the spread of vancomycin-resistant enterococci. Archives of Internal Medicine 1998; 158: 11271132.
28.Leflon-Giubout, V, et al. Absence of CTX-M enzymes but high prevalence of clones, including clone ST131, among fecal Escherichia coli isolates from healthy subjects living in the area of Paris, France. Journal of Clinical Microbiology 2008; 46: 39003905.
29.Hay, AD, et al. The relationship between primary care antibiotic prescribing and bacterial resistance in adults in the community: a controlled observational study using individual patient data. Journal of Antimicrobial Chemotherapy 2005; 56: 146153.
30.Hannah, EL, et al. Drug-resistant Escherichia coli, rural Idaho. Emerging Infectious Diseases 2005; 11: 16141617.
31.Storby, K, Osterlund, A, Kahlmeter, G. Antimicrobial resistance in Escherichia coli in urine samples from children and adults: a 12 year analysis. Acta Paediatrica 2004; 93: 487491.
32.Johnson, JR, et al. Escherichia coli colonization patterns among human household members and pets, with attention to acute urinary tract infection. Journal of Infectious Diseases 2008; 197: 218224.
33.Lietzau, S, et al. Household contacts were key factor for children's colonization with resistant Escherichia coli in community setting. Journal of Clinical Epidemiology 2007; 60: 11491155.
34.Vincent, C, et al. Food reservoir for Escherichia coli causing urinary tract infections. Emerging Infectious Diseases 2010; 16: 8895.
35.Hannah, EL, et al. Molecular analysis of antimicrobial-susceptible and -resistant Escherichia coli from retail meats and human stool and clinical specimens in a rural community setting. Foodborne Pathogens and Disease 2009; 6: 285295.
36.Guinée, P, Ugueto, N, van Leeuwen, N. Escherichia coli with resistance factors in vegetarians, babies, and nonvegetarians. Applied Microbiology 1970; 20: 531535.
37.Akwar, TH, et al. Risk factors for antimicrobial resistance among fecal Escherichia coli from residents on forty-three swine farms. Microbial Drug Resistance 2007; 13: 6976.
38.Boerlin, P, Reid-Smith, R. Antimicrobial resistance: its emergence and transmission. Animal Health Research Reviews 2008; 9: 115126.
39.Nijssen, S, et al. Effects of reducing beta-lactam antibiotic pressure on intestinal colonization of antibiotic-resistant gram-negative bacteria. Intensive Care Medicine 2010; 36: 512519.
40.Raum, E, et al. Changes in Escherichia coli resistance patterns during and after antibiotic therapy: a longitudinal study among outpatients in Germany. European Journal of Clinical Microbiology and Infectious Diseases 2008; 14: 4148.
41.Maslow, JN, Lee, B, Lautenbach, E. Fluoroquinolone-resistant Escherichia coli carriage in long-term care facility. Emerging Infectious Diseases 2005; 11: 889894.
42.Degener, JE, et al. Faecal carriage of aerobic Gram-negative bacilli and drug resistance of Escherichia coli in different age-groups in Dutch urban communities. Journal of Medical Microbiology 1983; 16: 139145.
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