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dc.contributor.authorLeonard, AFC
dc.contributor.authorZhang, L
dc.contributor.authorBalfour, AJ
dc.contributor.authorGarside, R
dc.contributor.authorHawkey, PM
dc.contributor.authorMurray, AK
dc.contributor.authorUkoumunne, OC
dc.contributor.authorGaze, WH
dc.date.accessioned2018-03-13T11:17:31Z
dc.date.issued2018-01-15
dc.description.abstractBACKGROUND: Antibiotic-resistant bacteria (ARB) present a global public health problem. With numbers of community-acquired resistant infections increasing, understanding the mechanisms by which people are exposed to and colonised by ARB can help inform effective strategies to prevent their spread. The role natural environments play in this is poorly understood. This is the first study to combine surveillance of ARB in bathing waters, human exposure estimates and association between exposure and colonisation by ARB in water users. METHODS: 97 bathing water samples from England and Wales were analysed for the proportion of E. coli harbouring blaCTX-M. These data were used to estimate the likelihood of water users ingesting blaCTX-M-bearing E. coli. Having identified surfers as being at risk of exposure to ARB, a cross-sectional study was conducted. Regular surfers and non-surfers were recruited to assess whether there is an association between surfing and gut colonisation by blaCTX-M-bearing E. coli. RESULTS: 11 of 97 bathing waters sampled were found to contain blaCTX-M-bearing E. coli. While the percentage of blaCTX-M-bearing E. coli in bathing waters was low (0.07%), water users are at risk of ingesting these ARB. It is estimated that over 25 million water sports sessions occurred in 2015 resulting in the ingestion of at least one blaCTX-M-bearing E. coli. In the epidemiological survey, 9/143 (6.3%) surfers were colonised by blaCTX-M-bearing E. coli, as compared to 2/130 (1.5%) of non-surfers (risk ratio=4.09, 95% CI 1.02 to 16.4, p=0.046). CONCLUSIONS: Surfers are at risk of exposure to and colonisation by clinically important antibiotic-resistant E. coli in coastal waters. Further research must be done on the role natural environments play in the transmission of ARB.en_GB
dc.description.sponsorshipThis work was supported by the European Regional Development Fund [grant number 500020], and Lihong Zhang was supported by the Natural Environment Research Council [grant number NE/M011259/ 1]en_GB
dc.identifier.citationDOI:/10.1016/j.envint.2017.11.003en_GB
dc.identifier.doi10.1016/j.envint.2017.11.003
dc.identifier.otherS0160-4120(17)31234-5
dc.identifier.urihttp://hdl.handle.net/10871/32078
dc.language.isoenen_GB
dc.publisherElsevieren_GB
dc.relation.sourceThe environmental surveillance data supporting this publication can be publicly accessed in Open Research Exeter via the following persistent identifier: http://hdl.handle.net/10871/30448. Due to ethical concerns, the epidemiological data are not publicly available.en_GB
dc.relation.urlhttps://www.ncbi.nlm.nih.gov/pubmed/29343413en_GB
dc.relation.urlhttp://hdl.handle.net/10871/30448en_GB
dc.rights© 2017 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/BY/4.0/).en_GB
dc.subjectAntibiotic resistant bacteriaen_GB
dc.subjectCTX-Men_GB
dc.subjectCoastal watersen_GB
dc.subjectEscherichia colien_GB
dc.subjectSurfersen_GB
dc.titleExposure to and colonisation by antibiotic-resistant E. coli in UK coastal water users: environmental surveillance, exposure assessment, and epidemiological study (Beach Bum Survey) (article)en_GB
dc.typeArticleen_GB
dc.date.available2018-03-13T11:17:31Z
exeter.place-of-publicationNetherlandsen_GB
dc.descriptionThis is the author accepted manuscript. The final version is available from the publisher via the DOI in this record. The dataset associated with this article is located in ORE at: http://hdl.handle.net/10871/30448en_GB
dc.identifier.journalEnvironment Internationalen_GB


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