Epidemiology of Extended-spectrum beta-lactamase-producing Escherichia coli at the human-animal-environment interface in Wakiso district, Uganda

Background Extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-PE) represents a significant global public health concern. Much as humans, animals and environments harbor ESBL-PE, its epidemiology in Uganda is still not well understood. This study explains the epidemiology of ESBL-PE using the one health approach in selected farming households in Wakiso district, central Uganda. Methodology Environmental, human, and animal samples were collected from 104 households. Additional data were obtained using observation checklists and through interviews with household members using a semi-structured questionnaire. Surface swabs, soil, water, human and animal fecal samples were introduced onto ESBL chromogenic agar. The isolates were identified using biochemical tests and double-disk synergy tests. To assess associations, prevalence ratios (PRs) were computed using a generalized linear model (GLM) analysis with modified Poisson and a log link with robust standard errors in R software. Results A total of 82.7% (86/104) households had at least one positive ESBL-PE isolate. The overall prevalence of ESBL-PE at the human-animal-environment interface was approximately 25.0% (95% CI: 22.7-28.3). Specifically, animals, environment and humans had an ESBL-PE prevalence of 35.4%, 5.8%, and 45.4% respectively. Having visitors (adj PR= 1.19, 95% CI: 1.04-1.36), utilizing veterinary services (adj PR= 1.39, 95% CI: 1.20-1.61) and using animal waste for gardening (adj PR= 1.29, 95% CI: 1.05-1.60) were positively associated with ESBL-PE contamination. However, covering the drinking water container with a lid (adj PR= 0.84 95% CI: 0.73-0.96) was associated with absence of ESBL-PE. Conclusion There is wider dissemination of ESBL-PE in the environment, humans, and animals, indicating poor infection prevention and control (IPC) measures in the area. Improved collaborative one health mitigation strategies such as safe water chain, farm biosecurity, household and facility-based IPC measures are recommended to reduce the burden of antimicrobial resistance at community level. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement "This research (or “[initials of fellow]”) was supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Carnegie Corporation of New York (Grant No. G-19-57145), Sida (Grant No:54100113), Uppsala Monitoring Center, Norwegian Agency for Development Cooperation (Norad), and by the Wellcome Trust [reference no. 107768/Z/15/Z] and the UK Foreign, Commonwealth & Development Office, with support from the Developing Excellence in Leadership, Training and Science in Africa (DELTAS Africa) programme. The statements made and views expressed are solely the responsibility of the Fellow. In addition, CIDIMOH project under the NORHED II funding supported part of the laboratory component during analysis. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Makerere University School of Public Health (SPH) institutional review board (IRB), the National Council for Science and Technology of Uganda (UNCST) and the district officials (head of administration - Chief administrative officer, District veterinary officer, District health officer) all ruled for the study and awarded us letters of support to that effect allowing us to conduct the study in Wakiso district, central Uganda. The study obtained ethical approval from Makerere University School of Public Health Institutional Review Board (SPH-2021-167) and the Uganda National Council for Science and Technology (HS1919ES). In addition, we obtained permission to conduct the study from Wakiso district headquarters (Chief administrative officer and district health and veterinary offices). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors * AMR : Antimicrobial resistance ARP : Antimicrobial Resistant pathogens E. coli : Escherichia coli ESBL-PE : Extended Spectrum Beta Lactamase Producing- E. coli IPC : Infection Prevention and Control LMICs : Low-and middle-income countries NAP : National Action Plan for Antimicrobial Resistance PPE : Personal Protective Equipment WHO : World Health Organization