Spillover of antibiotic resistance at the human-food animal interface

My primary interest is the impact of antibiotic use in food animals on the selection and spread of resistant pathogens to humans. Previously, I’ve examined spill-over of pig-origin, multidrug-resistant Staph aureus to food production workers and their household members in North Carolina. More recently, I’ve been exploring the circular transmission of multidrug-resistant Enterobacteriaceae (and the mobile resistance elements they harbor) between humans and animals in middle-income countries, where intensive animal production that relies on routine antibiotic use is expanding:

  • Nadimpalli ML, Viau R, Stegger M, et al. Common mobile genetic element harboring blaCTX-M-55 and qnrS in diverse human- and animal-origin Escherichia coli, Cambodia. Applied Bioinformatics & Public Health Microbiology. June 5-7, 2019. Hinxton, UK.

  • Nadimpalli M, Yith V, de Lauzanne A, et al. Meat and fish as sources of extended-spectrum B-lactamase-producing Escherichia coli, Cambodia. Emerg Infect Dis 2019; 25(1). [link]

  • Nadimpalli M, Delarocque-Astagneau E, Love DC, et al. Combating Global Antibiotic Resistance: Emerging One Health Concerns in Lower and Middle-Income Countries (Editor's Choice). Clin Infect Dis. 2018;66(6):963-969. doi:10.1093/cid/cix879. [link]

  • Nadimpalli ML, Stewart JR, Pierce E, et al. Face mask use and persistence of livestock-associated Staphylococcus aureus nasal carriage among industrial hog operation workers and household contacts, USA. Environ Health Perspect 2018;126(12). [link]

  • Rinsky JL, Nadimpalli M, Wing S, et al. Livestock-Associated Methicillin and Multidrug Resistant Staphylococcus aureus Is Present among Industrial, Not Antibiotic-Free Livestock Operation Workers in North Carolina. PLoS One. 2013;8(7):e67641. [link]

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Role of the gut microbiome in conferring protection against multidrug-resistant pathogens

Currently, I am exploring how differences in the gut microbiome might underlie children's differential susceptibility to gut-colonization with multidrug-resistant pathogens that are otherwise widely present in low-resource settings, including in contaminated food, drinking water, and household soil. I am especially interested in the role that breastfeeding and human milk could play in preventing the establishment, proliferation, and/or selection of antimicrobial-resistant bacteria among young children via modifications to the gut environment, a relatively unexplored topic:

  • Nadimpalli M, Bourke CD, et al. Can breastfeeding protect against antimicrobial resistance? BMC Med 2020; 18: 392. https://doi.org/10.1186/s12916-020-01862-w. [link]

I was recently awarded a NIH/NCATS KL2 Career Development award from Tufts' Clinical and Translational Science Institute to explore these research questions in an urban informal settlement of Lima, Peru.

Antibiotic resistance and inequality

The most vulnerable groups in our society - including racial and ethnic minorities and the economically disadvantaged - might also be most at risk of exposure to drug-resistant pathogens. Global changes in climate, urbanization, food production, and income inequality could worsen disparities unless we begin to identify and address them now. I’m interested in working with clinicians, spatial scientists, and educators to explore the scale, scope, and underlying factors driving racial and ethnic disparities in community-acquired, drug-resistant infections in the United States and globally:

  • Nadimpalli M, Chan C, Doron S. Antibiotic resistance: A call to action to prevent the next epidemic of inequality. Nat Med, in press

  • Nadimpalli ML, Marks S, Montealegre MC, et al. Urban informal settlements as hotspots of antimicrobial resistance and the need to curb environmental transmission. Nat Microbiol. 2020;5, 787–795. doi: https://doi.org/10.1038/s41564-020-0722-0 [link]. Editorial titled "Antimicrobial resistance in the age of COVID-19" about this publication: [link]

The above infographics were designed by myself and Madeline Verbica, curriculum illustrator for Great Diseases. You can find detailed summaries (including references) here.