Epidemiology of Carbapenem-Resistant Enterobacteriaceae in Households of UTI Outpatients in Southwestern Uganda: An Urgent Need for One Health Approach

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Background: Carbapenem-resistant Enterobacteriaceae (CRE) pose a major public health threat due to limited treatment options. Resistance driven by carbapenemase enzymes (such as blaVIM, blaKPC, blaIMP, blaNDM, and blaOXA-48), enables CRE to spread beyond healthcare settings into communities. The One Health approach is crucial for understanding the transmission pathways. This study investigated CRE distribution, resistance patterns, and genetic mechanisms among urinary tract infection (UTI) patients, their households, livestock, and environmental sources to inform strategies for controlling its spread. Methods: A cross-sectional study was conducted in two health centers in rural southwestern Uganda, involving 104 households (human, livestock and environment) of UTI outpatients who had Enterobacteriaceae harboring carbapenemase genes. The outpatients were traced to their homes. Urine samples were collected from a household member, stool samples from livestock, and boot sock samples from the environment. Enterobacteriaceae were identified, and the carbapenemase resistance genes (blaVIM, blaOXA-48, blaNDM, blaKPC, and blaIMP) identified using polymerase chain reaction. Data were analyzed using descriptive statistics and presented as frequencies and proportions in tables and charts. Results: Escherichia coli was the most abundant organism, while livestock demonstrated the most abundant growth of Enterobacteriaceae. Phenotypic carbapenem resistance was highest in the environment isolates (47.73%) whereas the genotypic carbapenemase resistance was highest in both human and environment isolates. Nearly a fifth of the households had at least one isolate carrying a carbapenemase gene, and 40% of the households had identical carbapenemase genes with UTI patients. Conclusions: The identification of matching carbapenemase genes between UTI patients and household isolates highlights the urgent need for targeted surveillance and infection control strategies to mitigate the spread of resistant pathogens. One Health epidemiological study designs are necessary for explaining the principal routes and dynamics of the spread of AMR bacteria between humans, livestock and the environment.

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