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Brenda L. Coleman, Allison McGeer, Marina Salvadori, Ian Johnson, Iris Gutmanis,

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.

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Brenda L. Coleman, Allison McGeer, Marina Salvadori, Ian Johnson, Iris Gutmanis,

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  1. 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

  2. Antimicrobial Resistance • What is it? • Why do we care? • How does it occur? • Selective pressure • Transmission

  3. Escherichia coli • Human colonization • Human infection • Water as a vehicle for transmission • E. coli indicator of contamination

  4. Private drinking water • 10-50% of Canadian households • 30-50% test water • 2-20% contaminated with E. coli

  5. Objectives • Measure the proportion of E. coli positive water samples that are antimicrobial resistant (AR) • Measure the prevalence of human carriage of AR E. coli • Determine whether the use of water contaminated with AR E. coli is associated with human carriage

  6. Sampling

  7. Water samples 340,009 tested  15,238 E. coli (4.5%)  6,492 susceptibility tested  645 resistant(9.9%)

  8. Human samples

  9. 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

  10. Proportion of rectal swabs with AR E. coliOntario, 2005-2007

  11. Theorized relationship between human carriage & consumption of antimicrobial resistant E. coli Potential effect modifier: Bottled water Primary predictor:Outcome: Water used 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

  12. 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

  13. Limitations • Convenience sample • Age of subjects • Lack of exposure dose/treatment of water • Causation

  14. 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

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