Antimicrobial resistance (AMR), especially among Enterobacteriaceae, is a significant global health problem, leading to increases in morbidity, mortality and healthcare costs. The threat of AMR in low to middle-income countries is especially dire due to an increasing prevalence of infections that are not treatable by last-line antimicrobials. AMR in bacteria develops from a wide variety of risk factors, including misuse of antimicrobials and environmental exposures to bacteria from livestock that are treated with antimicrobials. AMR is often examined in hospital settings, however, communityacquired AMR has been poorly described in terms of what risk factors are driving is. Poor water, sanitation, and hygiene (WASH) conditions, as well as low socioeconomic status (SES) have bene found to be associated with increased AMR in communities. Additionally, studies have shown that antimicrobial residues and multi-drug resistant (MDR) bacteria are common in surface waters around the world. Proper WASH infrastructure can help reduce the burden of infectious disease in communities, including the burden of antimicrobial-resistance bacteria. Prior studies have shown that low SES negatively impacts AMR colonization, with wealthier communities demonstrating less AMR organisms. Unfortunately, most studies to date have studied these question using ecological analyses, not at the individual or household level. Research on the relationship of AMR and environmental factors and socioeconomic factors represents an important gap in the literature that I aim to characterize.

Through this project, I will be examining the colonization of children with extendedspectrum ß lactamase (ESBL)-producing E. coli and MDR E. coli living within five periurban parishes east of Quito, Ecuador.