Risk factors for antibiotic resistant infections in a rural developing country setting: Human and animal agricultural antibiotic use and animal husbandry practices in rural Bangladesh

Background. The emergence of antibiotic resistant pathogens is increasing the proportion of infectious disease deaths globally and this burden is greatest in developing countries. Studies from developed countries have shown that animal agricultural antibiotic use, along with human use, is an important risk factor for resistant human infections. Understanding local human and animal agricultural antibiotic use is necessary to forestall emergence of resistance. No studies to date have examined both in a developing country.; Objective. To test the hypothesis that human carriage of resistant pneumococci is associated with animal or human antimicrobial use at the household level. To describe animal and human medicine use practices at the household level; and animal husbandry practices that put humans at risk for the acquisition of resistant pathogens.; Methods. Qualitative data collection (semi-structured and in-depth interviews, field observations, collection of pharmaceutical sales records), quantitative structured survey in 700 households, and nasal swab sampling in rural Bangladesh. Multiple logistic regression was used to assess factors associated with: (1) resistant pneumococci; and (2) animal and human antibiotic use.; Findings. The prevalence of resistant pneumococci to commonly used drugs cotrimoxazole, gentamicin, and tetracycline was high; 52.5%, 18.9% and 30% respectively. A total of 75.2% subjects demonstrated resistance to one or more antibiotics. In the study area the most commonly sold antibiotic for animals was oxytetracycline and for humans was cotrimoxazole. Animal husbandry practices emerged that increase risk for acquisition of resistant pathogens including: shared housing between animals and people (63%); gender roles that dictate females take care of poultry and children (86%); and shared water sources between livestock and humans (85%). There was a slightly significant increased odds of at least one household member carrying resistant pneumococcus and (1) the presence of antibiotics [AOR 1.42 (0.98, 2.06); p-val=0.067] and (2) a weak association with animal antibiotic use [OR 2.92 (0.77, 11.17); p-val=0.105].; Interpretation. The relationship between animal and human antibiotic use and resistant pneumococci may be underestimated because of misclassification of antibiotic use. In developing countries humans and animals live in close proximity and the growing phenomenon of household animal antibiotic use may be putting people at risk for the acquisition of untreatable infections and adding to the already high prevalence of resistant pathogens.