TY - JOUR
T1 - Exposure Assessment of Antimicrobial Resistant E. coli via Self-Supplied Drinking Water in Indonesia
T2 - Evaluating Boiling and Storage Practice Effectiveness
AU - Daly, Sean W.
AU - Foster, Tim
AU - Willetts, Juliet
AU - Putri, Gita L.
AU - Priadi, Cindy
AU - Harris, Angela R.
N1 - Publisher Copyright:
© 2024 American Chemical Society.
PY - 2024/10/11
Y1 - 2024/10/11
N2 - The rise of antimicrobial resistance is a rapidly worsening global health threat. Household water treatment and storage (HWTS) strategies are commonly employed in low-income settings to prevent the ingestion of unsafe drinking water. In order to evaluate the potential exposure to E. coli and cefotaxime-resistant E. coli via drinking water in Bekasi, Indonesia, we sampled drinking water sources (boreholes, protected/unprotected wells, bottled/refill) and point-of-use water from approximately 54 households during both wet season and dry season in 2020. Monte Carlo simulations were then used to estimate daily and annual exposure to both E. coli and cefotaxime-resistant E. coli. E. coli and cefotaxime-resistant E. coli were detected at 67.5% (77/114) and 28.1% (32/114) of source water samples, respectively. Median exposure estimates were reduced by approximately 1 order of magnitude for each log-removal of E. coli, and the proportion of the population exposed to E. coli that corresponds to a boiling efficiency of 0 (i.e., untreated), 2, and 4 log-removals was 68%, 54%, and 14%, respectively. Even when water boiling strategies achieve log-removal levels typically observed in practice or when they achieve “most protective” levels, fractions of the population may still be exposed to both E. coli and resistant E. coli.
AB - The rise of antimicrobial resistance is a rapidly worsening global health threat. Household water treatment and storage (HWTS) strategies are commonly employed in low-income settings to prevent the ingestion of unsafe drinking water. In order to evaluate the potential exposure to E. coli and cefotaxime-resistant E. coli via drinking water in Bekasi, Indonesia, we sampled drinking water sources (boreholes, protected/unprotected wells, bottled/refill) and point-of-use water from approximately 54 households during both wet season and dry season in 2020. Monte Carlo simulations were then used to estimate daily and annual exposure to both E. coli and cefotaxime-resistant E. coli. E. coli and cefotaxime-resistant E. coli were detected at 67.5% (77/114) and 28.1% (32/114) of source water samples, respectively. Median exposure estimates were reduced by approximately 1 order of magnitude for each log-removal of E. coli, and the proportion of the population exposed to E. coli that corresponds to a boiling efficiency of 0 (i.e., untreated), 2, and 4 log-removals was 68%, 54%, and 14%, respectively. Even when water boiling strategies achieve log-removal levels typically observed in practice or when they achieve “most protective” levels, fractions of the population may still be exposed to both E. coli and resistant E. coli.
KW - antimicrobial resistance
KW - household water treatment and storage
KW - low- and middle-income country
KW - Monte Carlo simulations
UR - http://www.scopus.com/inward/record.url?scp=85205690731&partnerID=8YFLogxK
U2 - 10.1021/acsestwater.4c00381
DO - 10.1021/acsestwater.4c00381
M3 - Article
AN - SCOPUS:85205690731
SN - 2690-0637
VL - 4
SP - 4423
EP - 4432
JO - ACS ES and T Water
JF - ACS ES and T Water
IS - 10
ER -