{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:51:38Z","timestamp":1787010698076,"version":"build-2736575974"},"posted":{"date-parts":[[2024,2,5]]},"group-title":"Public and Global Health","reference-count":92,"publisher":"openRxiv","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2024,2,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>\n                  We evaluated gut carriage of extended spectrum beta lactamase producing\n                  <jats:italic>Enterobacteriaceae<\/jats:italic>\n                  (ESBL-E) in southeastern U.S. residents without recent in-patient healthcare exposure. Study enrollment was January 2021-February 2022 in Athens, Georgia, U.S. and included a diverse population of 505 adults plus 50 child participants (age 0-5). Based on culture-based screening of stool samples, 4.5% of 555 participants carried ESBL-Es. This is slightly higher than reported in studies conducted 2012-2015, which found carriage rates of 2.5-3.9% in healthy U.S. residents.\n                <\/jats:p>\n                <jats:p>\n                  All ESBL-E confirmed isolates (n=25) were identified as\n                  <jats:italic>Escherichia coli<\/jats:italic>\n                  . Isolates belonged to 11 sequence types, with 48% classified as ST131. Ninety six percent of ESBL-E isolates carried a\n                  <jats:italic>\n                    bla\n                    <jats:sub>CTX-M<\/jats:sub>\n                  <\/jats:italic>\n                  gene. Isolated ESBL-Es frequently carried virulence genes as well as multiple classes of antibiotic resistance genes. Long-term colonization was common, with 64% of ESBL-E positive participants testing positive when rescreened three months later. One participant yielded isolates belonging to two different\n                  <jats:italic>E. coli<\/jats:italic>\n                  sequence types that carried\n                  <jats:italic>\n                    bla\n                    <jats:sub>CTX-M-1<\/jats:sub>\n                  <\/jats:italic>\n                  genes on near-identical plasmids, suggesting intra-gut plasmid transfer.\n                <\/jats:p>\n                <jats:p>\n                  Isolation of\n                  <jats:italic>E. coli<\/jats:italic>\n                  on media without antibiotics revealed that ESBL-\n                  <jats:italic>E. coli<\/jats:italic>\n                  typically made up a minor fraction of the overall gut\n                  <jats:italic>E. coli<\/jats:italic>\n                  population, although in some cases they were the dominant strain. ESBL-E carriage was not associated with a significantly different stool microbiome composition. However, some microbial taxa were differentially abundant in ESBL-E carriers. Together, these results suggest that a small subpopulation of US residents are long-term, asymptomatic carriers of ESBL-Es, and may serve as an important reservoir for community spread of these ESBL genes.\n                <\/jats:p>\n                <jats:sec>\n                  <jats:title>Importance<\/jats:title>\n                  <jats:p>\n                    Antibiotic resistant bacteria, especially\n                    <jats:italic>Enterobacteriaceae<\/jats:italic>\n                    carrying ESBLs, have become an increasing public health threat. Increasing numbers of community-associated infections (47% of ESBL-E infections in the U.S.) in participants without healthcare exposure is particularly concerning. This study found that 4.5% of a southeastern United States study population, without in-patient healthcare exposure, were asymptomatically colonized with ESBL-E, and 64% of ESBL-E positive participants were still positive when rescreened 3 months later. This suggests that the gut microbiome of healthy participants may represent an understudied community reservoir of ESBL genes and ESBL\n                    <jats:italic>Escherichia coli<\/jats:italic>\n                    in the U.S.\n                  <\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2024.02.03.24302254","type":"posted-content","created":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T13:20:51Z","timestamp":1707139251000},"source":"Crossref","is-referenced-by-count":7,"title":["Long-term gut colonization with ESBL-producing\n                  <i>Escherichia coli<\/i>\n                  in participants without known risk factors from the southeastern United States"],"prefix":"10.64898","author":[{"given":"Coralis Rodriguez","family":"Garcia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William A.","family":"Norfolk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda K.","family":"Howard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda L.","family":"Glatter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan S.","family":"Beaudry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas A.","family":"Mallis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Welton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Travis C.","family":"Glenn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8066-0636","authenticated-orcid":false,"given":"Erin K.","family":"Lipp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7898-2425","authenticated-orcid":false,"given":"Elizabeth A.","family":"Ottesen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2024020712100965000_2024.02.03.24302254v1.1","unstructured":"WHO Association Media Centre. 2015. 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