One Health Surveillance of Multidrug-Resistant Diarrheagenic Escherichia coli in Northeast India

Shivani Popli Goyal¹Samaresh Das²Karma G Dolma³Swagnik Roy⁴Tapan Kumar Dutta⁵Rajkumari Mandakini Devi⁶Megongusie Meru⁷Hosterson Kylla⁸W Valarie Lyngdoh⁹Suranjana Hazarika¹⁰Pallab Sarmah¹¹Sarangthem Indira Devi¹²Tapan Mazumdar¹³Dilem Modi¹⁴Thandavarayan Ramamurthy¹⁵Madhuchhanda Das^1*

• ¹Indian Council of Medical Research (ICMR), New Delhi, India
• ²Centre for Development of Advanced Computing- Kolkata, Kolkata, India
• ³Sikkim Manipal Institute of Medical Sciences, Gangtok, India
• ⁴Zoram Medical College, Falkawn, India
• ⁵College of Veterinary Sciences & Animal Husbandry, Central Agricultural University-Imphal, Mizoram, India, Mizoram, India
• ⁶College of Veterinary Sciences & Animal Husbandry, Central Agricultural University-Imphal, Nagaland, India, Nagaland, India
• ⁷Department of General Medicine, Christian Institute of Health Sciences and Research, Nagaland, India
• ⁸State Disease Diagnostic Laboratory, Shillong, India
• ⁹North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Meghalaya, India
• ¹⁰Gauhati Medical College and Hospital, Guwahati, India
• ¹¹ICMR - Regional Medical Research Centre Dibrugarh, Dibrugarh, India
• ¹²Institute of Bioresources and Sustainable Development, Imphal, India
• ¹³Agartala Government Medical College, Agartala, India
• ¹⁴Bakin Pertin General Hospital, Arunachal Pradesh, India
• ¹⁵ICMR - National Institute for Research in Bacterial Infections, Kolkata, India

The emerging antimicrobial resistance (AMR) in diarrheagenic Escherichia coli (DEC) has become a critical public health concern worldwide. The present study provides a comprehensive surveillance report on the distribution and AMR profile of DEC in humans, animals and food across Northeast India using the "One Health" approach. Of the 8149 stool specimens from hospitals, 20691 market foods and 2094 animal samples collected between October 2020 and December 2024, DEC was detected in 61.2%, 20% and 28.2% of the samples , respectively, with predominance of enteropathogenic E. coli. Geographically, Sikkim exhibited the highest incidence of DEC in hospital samples (63.7%), followed by Mizoram (28.2%), while food surveillance suggested a higher prevalence in Mizoram (54%). AMR profiling revealed a high level of resistance against ampicillin (69.5%), azithromycin (68.4%) and cefoxitin (62%) in human isolates, with 75% classified as MDR/XDR. Food isolates also exhibited higher levels of resistance against ampicillin (83.2%), azithromycin (73.6%) and cephalosporins (46-70.9%), with MDR/XDR prevalence of 73.4%. Similarly, animal isolates showed higher level of resistance against ampicillin (71.6%), azithromycin (52%), cephalosporins (42.8-64%) and tetracycline (50.5%) with MDR/XDR prevalence of 88.2%. Emerging resistance against carbapenems in the three different sources has also been detected. Correlation analysis revealed a strong link between AMR patterns in humans and food (r = 0.95), suggesting overlapping reservoirs and shared selection pressures between humans and food. Principal component analysis further corroborated the interaction between humans, food and animals DEC, underscoring the urgent need for stringent antimicrobial stewardship, a systematic surveillance system and improved hygiene practices to mitigate the spread of MDR-DEC.