Urinary lead level and colonization by antibiotic resistant bacteria: Evidence from a population-based study

Shoshannah Eggers, Nasia Safdar, Ashley Kates, Ajay K. Sethi, Paul E. Peppard, Marty S. Kanarek, Kristen M.C. Malecki

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Infection by antibiotic resistant bacteria (ARB) is a global health crisis and asymptomatic colonization increases risk of infection. Nonhuman studies have linked heavy metal exposure to the selection of ARB; however, few epidemiologic studies have examined this relationship. This study analyzes the association between urinary lead level and colonization by ARB in a nonclinical human population. Methods: Data came from the Survey of the Health of Wisconsin 2016-2017, and its ancillary Wisconsin Microbiome Study. Urinary lead levels, adjusted for creatinine, were used to assess exposure. ARB included methicillin resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), fluoroquinolone resistant Gram-negative bacilli (RGNB), and Clostridium difficile (C. diff), from skin, nose, and mouth swabs, and saliva and stool samples. Logistic regression, adjusted for covariates, was used to evaluate associations between Pb and ARB. Secondary analysis investigated Pb resistance from ARB isolates. Results: Among 695 participants, 239 (34%) tested positive for ARB. Geometric mean urinary Pb (unadjusted) was 0.286 μg/L (95% confidence intervals [CI] = 0.263, 0.312) for ARB negative participants and 0.323 μg/L (95% CI = 0.287, 0.363) for ARB positive participants. Models adjusted for demographics, diet, and antibiotic use showed elevated odds of positive colonization for those in the 95th percentile (vs. below) of Pb exposure (odds ratio [OR] = 2.05, 95% CI = 0.95, 4.44), and associations were highest in urban residents (OR = 2.85, 95% CI = 1.07, 7.59). RGNB isolates were most resistant to Pb. Discussion: These novel results suggest that Pb exposure is associated with increased colonization by ARB, and that RGNB are particularly resistant to Pb.

Original languageEnglish
Pages (from-to)E175
JournalEnvironmental Epidemiology
Issue number6
StatePublished - 3 Dec 2021


  • Antibiotic resistance
  • C. diff
  • Environmental epidemiology
  • Heavy metals
  • Infectious disease epidemiology
  • Lead


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