Link Between Hospitals, Sanitation Practices and Antibiotic Resistance in Guatemala

Recent research conducted in Guatemala highlights a significant connection between healthcare facility visits, sanitation conditions, and the spread of antibiotic-resistant bacteria within communities. Led by Washington State University, the study found that individuals who visited hospitals or clinics are at a higher risk of carrying bacteria resistant to critical antibiotics, such as extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE), rather than antibiotic consumption itself.

Previous studies in the Western Highlands revealed that nearly 46% of residents carried bacteria like E. coli that resist common antibiotics like ceftriaxone, complicating treatment for infections. The current investigation involved 951 residents from the same region and aimed to identify the key factors associated with colonization by resistant bacteria.

According to lead researcher Dr. Brooke Ramay, understanding these risk factors enables targeted interventions to reduce bacterial colonization and spread. Her team emphasizes that colonization, where bacteria inhabit the body without causing disease, is a precursor to potential infections if bacteria enter vulnerable sites like the bloodstream or urinary tract.

The study suggests that exposure to healthcare environments—through contact with contaminated surfaces, medical equipment, or staff—may facilitate bacterial transfer. Furthermore, individuals needing medical care often have underlying conditions such as chronic illnesses, diarrhea, or malnutrition, which may increase susceptibility.

The research also identified that urban residents and households without waste collection services are approximately twice as likely to carry resistant bacteria, while water source plays a role—with those using piped or well water about 1.5 times more likely to be colonized than those using bottled water. Interestingly, no significant association was found between antibiotic use and colonization, underscoring the importance of hygiene and environmental factors.

This study forms part of the broader Antimicrobial Resistance in Communities and Hospitals (ARCH) project, which spans six countries and shows varying prevalence rates, from 24% in Botswana to 78% in Bangladesh. While such resistant bacteria are still relatively rare in the U.S., global travel and trade pose a risk of spreading these pathogens.

Ramay emphasizes that bacteria and resistance genes do not respect borders, and efforts to address colonization abroad are crucial to slowing their worldwide transmission.