Effects of a community-based intervention bundle on household transmission of extended spectrum β-lactamase-producing Escherichia coli in rural Burkina Faso to target community-level drivers of antimicrobial resistance in sub-Saharan Africa: a cluster-randomised trial

@article{aizouk2026effects,
  title = {{Effects of a community-based intervention bundle on household transmission of extended spectrum β-lactamase-producing Escherichia coli in rural Burkina Faso to target community-level drivers of antimicrobial resistance in sub-Saharan Africa: a cluster-randomised trial}},
  author = {Raneem Aizouk and Yougbaré Sibidou and Daniel Valia and Brecht Ingelbeen and Linda Campbell and Juste Stéphane Kouanda and Aminata Welgo and Papa Mamadou Diagne and Bram Riems and Liselotte Hardy and Edwin Wouters and Marie Meudec and Marianne a B van der Sande and Tinto Halidou and Ben S Cooper and Esther van Kleef and Iana Amke-Lowrey-Gold and César-Augustin Mambuku Khoso Muaka and Adna Melanda and Richelin Makuaya and Didier Ndomba and Delphin Mavinga Phanzu and Djibril Binga and Anicet Nzuzi and Guy Crispin Gembu and Tamara Giles-Vernick and Leonard Heyerdahl and Herwig Leirs and Joachim Marien and Sandra van Puyvelde and Rianne van Vredendaal and Oscar Kiabanza and Toussaint Rouamba and Franck Sovi Hien and Eric Wendpouiré Tiendrébeogo},
  journal = {The Lancet Microbe},
  year = {2026},
  month = oct,
  doi = {10.1016/j.lanmic.2026.101427},
  url = {https://hal.science/hal-05777887v1},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Effects of a community-based intervention bundle on household transmission of extended spectrum β-lactamase-producing Escherichia coli in rural Burkina Faso to target community-level drivers of antimicrobial resistance in sub-Saharan Africa: a cluster-randomised trial
AU  - Raneem Aizouk
AU  - Yougbaré Sibidou
AU  - Daniel Valia
AU  - Brecht Ingelbeen
AU  - Linda Campbell
AU  - Juste Stéphane Kouanda
AU  - Aminata Welgo
AU  - Papa Mamadou Diagne
AU  - Bram Riems
AU  - Liselotte Hardy
AU  - Edwin Wouters
AU  - Marie Meudec
AU  - Marianne a B van der Sande
AU  - Tinto Halidou
AU  - Ben S Cooper
AU  - Esther van Kleef
AU  - Iana Amke-Lowrey-Gold
AU  - César-Augustin Mambuku Khoso Muaka
AU  - Adna Melanda
AU  - Richelin Makuaya
AU  - Didier Ndomba
AU  - Delphin Mavinga Phanzu
AU  - Djibril Binga
AU  - Anicet Nzuzi
AU  - Guy Crispin Gembu
AU  - Tamara Giles-Vernick
AU  - Leonard Heyerdahl
AU  - Herwig Leirs
AU  - Joachim Marien
AU  - Sandra van Puyvelde
AU  - Rianne van Vredendaal
AU  - Oscar Kiabanza
AU  - Toussaint Rouamba
AU  - Franck Sovi Hien
AU  - Eric Wendpouiré Tiendrébeogo
PY  - 2026
DA  - 2026/10/05
JO  - The Lancet Microbe
DO  - 10.1016/j.lanmic.2026.101427
UR  - https://hal.science/hal-05777887v1
AB  - Background In sub-Saharan Africa, invasive antimicrobial-resistant infections often originate from community-level acquisition. In this study, we aimed to evaluate the effect of a cluster-level intervention on individual-level extended spectrum β-lactamase-producing Escherichia coli (ESBL-E) acquisition. We assessed whether a behavioural intervention bundle targeting suboptimal antibiotic use and hygiene practices reduced household-level acquisition of ESBL-E.  MethodsWe conducted a cluster-randomised controlled trial in 22 village clusters in Nanoro district, Burkina Faso. We enrolled 12 randomly selected households per cluster to assess the intervention effect on ESBL-E household transmission. The intervention comprised three rounds delivered at 3-month intervals and combined WHO Access, Watch, Reserve-based educational and feedback sessions for formal and informal medicine providers with community health education campaigns. Consenting household members provided stool samples before, during, and after intervention rollout, alongside a pre-post household water, sanitation, and hygiene (WASH) survey. ESBL-E acquisition was defined as a transition from a negative to a positive stool sample between consecutive sampling visits, with transition hazards estimated using continuous-time Markov models. We estimated intervention effects on ESBL-E acquisition using Bayesian Markov models. Cox frailty models assessed associations between WASH exposures and acquisition. The study is registered with ClinicalTrials.gov (NCT05378880). Findings 1203 individuals were enrolled between Oct 11, 2022, and Feb 19, 2024. At baseline, 346 (57%) of 604 individuals in the control household group and 291 (49%) of 599 individuals in the intervention household group tested positive for ESBL-E colonisation. Pre-intervention acquisition incidence rates were 3⋅8 per 100 person-days (95% credible interval [CrI] 2⋅0-9⋅9) in the intervention group and 3⋅5 per 100 person-days (95% CrI 1⋅8-9⋅6) in the control group. The intervention did not change the risk of ESBL-E acquisition in months 1-6 (hazard ratio [HR] 1⋅02 [95% CrI 0⋅78-1⋅31]) but was associated with a reduction in months 6-9 (HR 0⋅82 [95% CrI 0⋅56-1⋅14], probability of a reduction p[HR<1]=0⋅88). Acquisition risk was higher in the rainy season (peak HR 1⋅73 [95% CI 1⋅49-2⋅00]), whereas improved sanitation was associated with lower risk (HR 0⋅77 [95% CI 0⋅59-1⋅00]).  Interpretation Findings, although inconclusive, were consistent with a modest intervention-related reduction in ESBL-E acquisition incidence. Higher acquisition rates associated with rainy seasons and poor sanitation highlight the need to tackle environmental drivers of antimicrobial resistance transmission in addition to antibiotic use in rural sub-Saharan Africa.
SN  - 2666-5247
ER  -