Multidrug-resistant Escherichia coli and its role in stunting: evidence from a cross-sectional study in Indonesia

Abstract

Introduction: This cross-sectional study aimed to investigate the relationship between environmental contamination and stunting among children under five years of age in Langkat, North Sumatra, Indonesia.

Methodology: This cross-sectional study was conducted from February to October 2024, involving 180 households with private drinking water sources. Stunting was assessed using height-for-age Z-scores (< -2 SD). Water samples were tested for E. coli and Coliforms using the membrane filtration method on Chromocult Coliform Agar, incubated at 37°C for 24 hours. E. coli was confirmed by IMViC biochemical tests, and antimicrobial resistance was assessed using the Kirby-Bauer disk diffusion method following CLSI guidelines.

Results: Water testing showed E. coli and Coliform bacteria in 75.4% and 80.7% of samples, indicating significant contamination. E. coli presence was significantly associated with stunting (p = 0.044), turbidity (p = 0.047), and diarrhea history (p = 0.004). Hierarchical regression identified E. coli, diarrhea, and turbidity as key stunting predictors, with E. coli showing a beta of -0.287 (p = 0.035). Multidrug resistance was high among E. coli isolates (n = 108), with 92.59% resistant to Tetracycline and Sulfamethoxazole, and 70.37% to Amoxicillin and Ampicillin, underscoring the need for targeted antimicrobial stewardship.

Conclusions: These findings highlight that environmental contamination, particularly from Escherichia coli, may represent a critical risk factor for stunting, emphasizing the need for improved water quality and hygiene practices in vulnerable communities.