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Silva LC, Sanches MS, Guidone GHM, Montini VH, de Oliva BHD, do Nascimento AB, Galhardi LCF, Kobayashi RKT, Vespero EC, Rocha SPD. Clonal relationship, virulence genes, and antimicrobial resistance of Morganella morganii isolated from community-acquired infections and hospitalized patients: a neglected opportunistic pathogen. Int Microbiol 2024; 27:411-422. [PMID: 37479959 DOI: 10.1007/s10123-023-00400-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/23/2023]
Abstract
Morganella morganii is a bacterium belonging to the normal intestinal microbiota and the environment; however, in immunocompromised individuals, this bacterium can become an opportunistic pathogen, causing a series of diseases, both in hospitals and in the community, being urinary tract infections more prevalent. Therefore, the objective of this study was to evaluate the prevalence, virulence profile, and resistance to antimicrobials and the clonal relationship of isolates of urinary tract infections (UTI) caused by M. morganii, both in the hospital environment and in the community of the municipality of Londrina-PR, in southern Brazil, in order to better understand the mechanisms for the establishment of the disease caused by this bacterium. Our study showed that M. morganii presents a variety of virulence factors in the studied isolates. Hospital strains showed a higher prevalence for the virulence genes zapA, iutA, and fimH, while community strains showed a higher prevalence for the ireA and iutA genes. Hospital isolates showed greater resistance compared to community isolates, as well as a higher prevalence of multidrug-resistant (MDR) and extended-spectrum beta lactamase (ESBL)-producing isolates. Several M. morganii isolates from both sources showed high genetic similarity. The most prevalent plasmid incompatibility groups detected were FIB and I1, regardless of the isolation source. Thus, M. morganii isolates can accumulate virulence factors and antimicrobial resistance, making them a neglected opportunistic pathogen.
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Affiliation(s)
- Luana Carvalho Silva
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Rodovia Celso Garcia Cid PO-BOX 6001, 86051-980, Londrina, Paraná, Brazil
| | - Matheus Silva Sanches
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Rodovia Celso Garcia Cid PO-BOX 6001, 86051-980, Londrina, Paraná, Brazil
| | - Gustavo Henrique Migliorini Guidone
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Rodovia Celso Garcia Cid PO-BOX 6001, 86051-980, Londrina, Paraná, Brazil
| | - Victor Hugo Montini
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Rodovia Celso Garcia Cid PO-BOX 6001, 86051-980, Londrina, Paraná, Brazil
| | - Bruno Henrique Dias de Oliva
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Rodovia Celso Garcia Cid PO-BOX 6001, 86051-980, Londrina, Paraná, Brazil
| | - Arthur Bossi do Nascimento
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Rodovia Celso Garcia Cid PO-BOX 6001, 86051-980, Londrina, Paraná, Brazil
| | - Lígia Carla Faccin Galhardi
- Laboratory of Virology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Renata Katsuko Takayama Kobayashi
- Laboratory of Basic and Applied Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Eliana Carolina Vespero
- Department of Pathology, Clinical and Toxicological Analysis, Health Sciences Center, University Hospital of Londrina, State University of Londrina, Paraná, Brazil
| | - Sergio Paulo Dejato Rocha
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Rodovia Celso Garcia Cid PO-BOX 6001, 86051-980, Londrina, Paraná, Brazil.
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Furusawa M, Widgren S, Evers EG, Fischer EAJ. Quantifying health risks from ESBL-producing Escherichia coli in Dutch broiler production chains and potential interventions using compartmental models. Prev Vet Med 2024; 224:106121. [PMID: 38271921 DOI: 10.1016/j.prevetmed.2024.106121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 12/28/2023] [Accepted: 01/10/2024] [Indexed: 01/27/2024]
Abstract
Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) in animals are considered a human health threat, because this type of bacteria can serve as a reservoir of antibiotic resistant genes and act as a continuous threat of the emergence of new resistant bacteria, in addition to the direct effect of making infection untreatable. Although the prevalence of ESBL producing bacteria in broilers was drastically reduced in the Netherlands, chicken meat still has the highest prevalence among meat products. Therefore, further control of the ESBL-producing E. coli in the broiler production chain is important to reduce public health risks. The main objectives of this study were to evaluate the effectiveness of intervention scenarios to reduce the transmission of ESBL-producing E. coli in the broiler production chain and to quantitatively estimate the risk to public health. In this study, we developed two different types of transmission models that described the observed time-related decline in prevalence during a production round: one with time-dependent decline in susceptibility and one with partial immunity to phylogenetic groups. Both models incorporated the environmental contamination effect between production rounds and within flocks. The parameter values, including transmission rate and recovery rate, were estimated by Approximate Bayesian computation (ABC) method using data from a longitudinal study in a Dutch organic broiler farm. We applied the models to the three production stages in the broiler production chain, beginning from the Parent Stock (PS) farms, the hatcheries, and to the broiler farms. In our models, eggs were collected from different parent stock farms and transported to the hatchery and from there to a broiler farm.The size of a flock and the number of farms were adjusted to the Dutch situation. Both models were able to describe the observed dynamics within and between the production stages equally well, with estimated ESBL-producing E. coli prevalence of 8.98% and 11.47% in broilers at slaughter and 0.12% and 0.15% in humans due to chicken consumption. Both models indicated that improving farm management to eliminate the bacteria from the environment was the most effective intervention, making this outcome robust. Although chicken meat consumption is not a major risk factor for human carriage of the bacteria according to our models, reducing the bacteria in the PS and broiler farm environment to at least one percent can further decrease the prevalence in humans.
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Affiliation(s)
- Minori Furusawa
- Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, the Netherlands; Ministry of Agriculture, Forestry and Fisheries, Japan
| | - Stefan Widgren
- Department of Disease Control and Epidemiology, National Veterinary Institute, Sweden
| | - Eric G Evers
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), the Netherlands
| | - Egil A J Fischer
- Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, the Netherlands.
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Meijs AP, Rozwandowicz M, Hengeveld PD, Dierikx CM, de Greeff SC, van Duijkeren E, van Dissel JT. Human carriage of ESBL/pAmpC-producing Escherichia coli and Klebsiella pneumoniae in relation to the consumption of raw or undercooked vegetables, fruits, and fresh herbs. Microbiol Spectr 2024; 12:e0284923. [PMID: 38206033 PMCID: PMC10845978 DOI: 10.1128/spectrum.02849-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024] Open
Abstract
We investigated to what extent the consumption of raw or undercooked vegetables, fruits, and fresh herbs influences carriage rates of ESBL/pAmpC-producing Escherichia coli and Klebsiella pneumoniae (ESBL-E/K) in the general population. We assessed long-term carriage and changes in ESBL-E/K prevalence over time, by comparing the results to findings in the same population 5 years earlier. Between July and December 2021, participants sent in two fecal samples and questionnaires, 3 months apart. Food frequency questionnaires were sent on a monthly basis. Fecal samples were cultured and screened for ESBL-E/K, and phenotypically positive isolates were sequenced. Multivariable logistic regression models were established to assess the association between the consumption of fresh produce and ESBL-E/K carriage. The ESBL-E/K prevalence was 7.6% [41/537; 95% confidence interval (CI): 5.7-10.2] in the first sampling round and 7.0% (34/489; 95% CI: 5.0-9.6) in the second. Multivariable models did not result in statistical significance for any of the selected fruit and vegetable types. Trends for increased carriage rates were observed for the consumption of raspberry and blueberry in the summer period. ESBL-E/K prevalence was comparable with the prevalence in the same cohort 5 years earlier (7.5%; 95% CI: 5.6-10.1%). In six persons (1.2%) a genetically highly homologous ESBL-E/K was found. In conclusion, the contribution of the consumption of raw fruits, vegetables, and herbs to ESBL-E/K carriage in humans in the Netherlands is probably low. Despite COVID-19 containment measures (e.g., travel restrictions, social distancing, and hygiene) the ESBL-E/K prevalence was similar to 5 years earlier. Furthermore, indications for long-term carriage were found.IMPORTANCEESBL-producing bacteria are resistant against important classes of antibiotics, including penicillins and cephalosporines, which complicates treatment of infections. Food is one of the main routes of transmission for carriage of these bacteria in the general population. Although fruits, vegetables, and herbs are generally less frequently contaminated with ESBL-producing bacteria compared to meat, exposure might be higher since these products are often eaten raw or undercooked. This research showed that the contribution of the consumption of raw or undercooked fresh produce to ESBL-E/K carriage in the general Dutch population was low. No specific types of fruit or vegetables could be identified that gave a higher risk of carriage. In addition, we demonstrated the presence of genetically highly homologous ESBL-E/K in six persons after a period of 5 years, indicative for long-term carriage.
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Affiliation(s)
- A. P. Meijs
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - M. Rozwandowicz
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - P. D. Hengeveld
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - C. M. Dierikx
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - S. C. de Greeff
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - E. van Duijkeren
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - J. T. van Dissel
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Department of Infectious Diseases and Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
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Araz H, Kocagül-Çelikbaş A, Altunsoy A, Mumcuoğlu I, Kazcı S, Köseoğlu HT. Treatment of Helicobacter Pylori İnfection and the Colonization of the Gastrointestinal System by Resistant Bacteria. Niger J Clin Pract 2024; 27:289-295. [PMID: 38409160 DOI: 10.4103/njcp.njcp_402_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 01/21/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND AND AIMS Helicobacter pylori (H. pylori) infections are widely treated with antibiotic regimens such as "Amoxicillin 1 gr 2 × 1 tablet, Clarithromycin 500 mg 2 × 1 tablet, and Lansoprazole 30 mg 2 × 1 tablet" for 14 days. We conducted a prospective observational study to explore whether this treatment protocol serves as a predisposing factor for the colonization of resistant gastrointestinal microflora, namely vancomycin-resistant enterococci (VRE), extended-spectrum beta-lactamase Enterobacterales (ESBL-E), and carbapenem-resistant Enterobacterales (CRE). MATERIALS AND METHODS Pre- and post-treatment stool samples from 75 patients diagnosed with H. pylori, without a prior treatment history, were cultured and evaluated based on the European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. RESULTS Of the 75 evaluated patients, a pronounced surge in ESBL-E positivity was observed. Before initiating antibiotic treatment, 12 patients (16%) had ESBL-E-positive strains in their gastrointestinal tract. Notably, this number surged to 24 patients (32%) after the conclusion of the 14-day treatment regimen. The change was statistically significant, with a P value of less than 0.002, indicating a clear association between treatment for H. pylori and heightened ESBL-E colonization. Notably, VRE and CRE remained undetected in patients throughout the study, suggesting that the treatment regimen may specifically amplify the risk of ESBL-E colonization without affecting VRE and CRE prevalence. CONCLUSIONS As the inaugural report from Turkey on this issue, our study suggests that antibiotic regimens for H. pylori eradication contribute to the increased risk of ESBL-positive bacterial colonization in the gastrointestinal tract.
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Affiliation(s)
- H Araz
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - A Kocagül-Çelikbaş
- Department of Infectious Diseases and Clinical Microbiology, Hitit University, Çorum, Turkey
| | - A Altunsoy
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - I Mumcuoğlu
- Department of Medical Microbiology, University of Health Sciences, Gulhane Medical School Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - S Kazcı
- Department of Medical Microbiology Clinic, Ankara City Hospital, Ankara, Turkey
| | - H T Köseoğlu
- Department of Gastroenterology Clinic, Ankara City Hospital, Ankara, Turkey
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Dequeker S, van Hensbergen M, den Heijer CDJ, Dhaeze W, Raven SFH, Ewalts-Hakkoer H, Tolsma P, Willemsen I, van Drunen-Kamp KJ, van der Slikke-Verstraten K, Goossens H, Kluytmans-van den Bergh MFQ, Hoebe CJPA. Cross-border differences in the prevalence and risk factors for carriage of antimicrobial resistance in children attending daycare centers: a point prevalence study in the Netherlands and Belgium. BMC Infect Dis 2024; 24:131. [PMID: 38267878 PMCID: PMC10809597 DOI: 10.1186/s12879-024-08996-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/09/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Day care centres (DCCs) are ideal settings for drug-resistant bacteria to emerge. Prevalence numbers of faecal carriage of antimicrobial resistant bacteria in these settings are rare. We aimed to determine the prevalence of faecal antimicrobial resistant bacteria carriage in children attending DCCs and to assess and identify infection risk factors within DCCs in The Netherlands and Belgium. METHODS A point-prevalence study was conducted in 28 Dutch (499 children) and 18 Belgian (448 children) DCCs. Stool samples were taken from the children's diapers and a questionnaire was filled in by their parents. Hygiene related to stool and toilet use, hygiene related to food, environmental contamination, hand hygiene and hygiene guidelines were assessed conform a standardized questionnaire by the infection prevention and control expert visiting the DCC. Multilevel logistical regression analyses were used to define which characteristics predicted the presence of extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E), carbapenemase-producing Enterobacterales (CPE), vancomycin-resistant enterococci (VRE), and ciprofloxacin-resistant Enterobacterales (CipR-E). RESULTS The ESBL-E prevalence was 16% (n = 71) in Belgium and 6% (n = 30) in the Netherlands. The CipR-E prevalence was 17% (n = 78) in Belgium and 8% (n = 38) in the Netherlands. Antimicrobial use (RR: 0.30; 95% CI: 0.33-0.48) and hospital admissions (RR: 0.37; 95% CI: 0.25-0.54) were lower in the Netherlands. Children travelling to Asia were at higher risk of being an ESBL-E carrier. Children using antimicrobials were at higher risk of being a CipR-E carrier. Cleaning the changing mat after each use was found as a protective factor for CipR-E carriage. CONCLUSIONS We established a significant difference in ESBL-E and CipR-E carriage and antimicrobial use and hospital admissions between the Netherlands and Belgium among children attending DCCs. The differences between both countries should be further studied to improve the policy on anti-microbial use and hospital admissions in children.
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Affiliation(s)
- Sara Dequeker
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium.
- Agency for Care and Health, Infection Prevention and Control, Government of Flanders, Brussels, Belgium.
| | - Mitch van Hensbergen
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, The Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
| | - Casper D J den Heijer
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, The Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
| | - Wouter Dhaeze
- Agency for Care and Health, Infection Prevention and Control, Government of Flanders, Brussels, Belgium
| | - Stijn F H Raven
- Department of Infectious Diseases, Public Health Service region Utrecht, Zeist, The Netherlands
| | | | - Paulien Tolsma
- Public Health Service Brabant-Zuidoost, Eindhoven, The Netherlands
| | - Ina Willemsen
- Contrain Infectiepreventiecoach, Breda, The Netherlands
- Amphia Hospital, Breda, The Netherlands
| | | | | | | | | | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, The Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), PO Box 5800, 6202, AZ, Maastricht, The Netherlands
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Vock I, Aguilar-Bultet L, Goldenberger D, Ragozzino S, Kuster S, Tschudin-Sutter S. Epidemiology of patients harboring carbapenemase-producing bacteria and comparison with patients with detection of extended-spectrum beta-lactamase-producing Enterobacterales-A retrospective cohort study. Infect Control Hosp Epidemiol 2023; 44:1959-1965. [PMID: 37424228 PMCID: PMC10755146 DOI: 10.1017/ice.2023.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE We evaluated the epidemiology of carbapenemase-producing bacteria (CPB) in Switzerland by comparing risk factors between patients colonized with CPB and patients colonized with extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE). METHODS This retrospective cohort study was conducted at the University Hospital Basel in Switzerland. Hospitalized patients with CPB in any sample between January 2008 and July 2019 were included. The ESBL-PE group consisted of hospitalized patients with detection of ESBL-PE from any sample between January 2016 and December 2018. Comparisons of risk factors for acquisition of CPB and ESBL-PE were performed by logistic regression. RESULTS Inclusion criteria were met for 50 patients in the CPB group and 572 in the ESBL-PE group. In the CPB group, 62% had a travel history and 60% had been hospitalized abroad. When comparing the CPB group to the ESBL-PE group, hospitalization abroad (odds ratio [OR], 25.33; 95% confidence interval [CI], 11.07-57.98) and prior antibiotic therapy (OR, 4.76; 95% CI, 2.15-10.55) remained independently associated with CPB colonization. Hospitalization abroad (P < .001) and prior antibiotic therapy (P < .001) predicted CPB in the comparison of CPB with ESBL Escherichia coli, whereas hospitalization abroad was associated with CPB in comparison to ESBL Klebsiella pneumoniae. CONCLUSIONS Although CPB still seem to be mainly imported from areas of higher endemicity, local acquisition of CPB is emerging, especially in patients with close and/or frequent contact with healthcare services. This trend resembles the epidemiology of ESBL K. pneumoniae, supporting mainly healthcare-associated transmission. Frequent evaluation of CPB epidemiology is required to improve detection of patients at risk of CPB carriage.
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Affiliation(s)
- Isabelle Vock
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Switzerland
| | - Lisandra Aguilar-Bultet
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Switzerland
| | - Daniel Goldenberger
- Division of Bacteriology and Mycology, University Hospital Basel, University Basel, Switzerland
| | - Silvio Ragozzino
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Switzerland
| | - Sabine Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University Basel, Switzerland
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Brachaczek P, Lonc A, Kretzschmar ME, Mikolajczyk R, Horn J, Karch A, Sakowski K, Piotrowska MJ. Transmission of drug-resistant bacteria in a hospital-community model stratified by patient risk. Sci Rep 2023; 13:18593. [PMID: 37903799 PMCID: PMC10616222 DOI: 10.1038/s41598-023-45248-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/17/2023] [Indexed: 11/01/2023] Open
Abstract
A susceptible-infectious-susceptible (SIS) model for simulating healthcare-acquired infection spread within a hospital and associated community is proposed. The model accounts for the stratification of in-patients into two susceptibility-based risk groups. The model is formulated as a system of first-order ordinary differential equations (ODEs) with appropriate initial conditions. The mathematical analysis of this system is demonstrated. It is shown that the system has unique global solutions, which are bounded and non-negative. The basic reproduction number ([Formula: see text]) for the considered model is derived. The existence and the stability of the stationary solutions are analysed. The disease-free stationary solution is always present and is globally asymptotically stable for [Formula: see text], while for [Formula: see text] it is unstable. The presence of an endemic stationary solution depends on the model parameters and when it exists, it is globally asymptotically stable. The endemic state encompasses both risk groups. The endemic state within only one group only is not possible. In addition, for [Formula: see text] a forward bifurcation takes place. Numerical simulations, based on the anonymised insurance data, are also presented to illustrate theoretical results.
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Affiliation(s)
- Paweł Brachaczek
- Faculty of Mathematics, Informatics and Mechanics, University of Warsaw, Banacha 2, 02-097, Warsaw, Poland
| | - Agata Lonc
- Faculty of Mathematics, Informatics and Mechanics, University of Warsaw, Banacha 2, 02-097, Warsaw, Poland
| | - Mirjam E Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometry, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Johannes Horn
- Institute for Medical Epidemiology, Biometry, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Andre Karch
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Konrad Sakowski
- Institute of Applied Mathematics and Mechanics, University of Warsaw, Banacha 2, 02-097, Warsaw, Poland.
| | - Monika J Piotrowska
- Institute of Applied Mathematics and Mechanics, University of Warsaw, Banacha 2, 02-097, Warsaw, Poland
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Moaligou C, Dion M, Ishnaiwer M, Dailly É, Batard É, Javaudin F. Pantoprazole promotes sustained intestinal carriage of multidrug-resistant Escherichia coli in amoxicillin-treated mice. J Appl Microbiol 2023; 134:lxad223. [PMID: 37766396 DOI: 10.1093/jambio/lxad223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/19/2023] [Accepted: 09/26/2023] [Indexed: 09/29/2023]
Abstract
AIMS The main objective of this study was to compare extended-spectrum β-lactamase (ESBL) Escherichia coli fecal titers during 12 days between two groups: mice who received proton pump inhibitors (PPIs) and those that did not. METHODS AND RESULTS We tested three different in vivo models: model 1, high inoculum (106 CFU ml-1); model 2, low inoculum (102 CFU ml-1); and model 3, low inoculum and 2-day amoxicillin wash-out. There was no significant difference between the two groups in fecal ESBL E. coli titers in models 1 and 2. The fecal titers of ESBL E. coli were probably too high to show differences in colonization related to PPI treatment. By introducing a 2-day wash-out period after stopping amoxicillin (model 3), the fecal ESBL E. coli titers were higher in the PPI-treated mice during 12 days (3 log versus 11 log day CFU g-1; P < 0.05). This result highlighted that PPIs promote stable ESBL E. coli digestive carriage in mice. Fecal quantitative PCR showed that mice with low ESBL E. coli fecal titers had a much higher concentration of equol-producing bacteria, Muribaculum sp., and Adlercreutzia caecimuris. CONCLUSIONS Pantoprazole treatment promotes sustained digestive carriage of ESBL E. coli in amoxicillin-treated mice.
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Affiliation(s)
- Camille Moaligou
- Cibles et médicaments des infections et de l'immunité, IICiMed, UR 1155, Nantes Université, Nantes 44000, France
| | - Michel Dion
- Cibles et médicaments des infections et de l'immunité, IICiMed, UR 1155, Nantes Université, Nantes 44000, France
| | - Murad Ishnaiwer
- Cibles et médicaments des infections et de l'immunité, IICiMed, UR 1155, Nantes Université, Nantes 44000, France
| | - Éric Dailly
- Cibles et médicaments des infections et de l'immunité, IICiMed, UR 1155, Nantes Université, Nantes 44000, France
- Clinical Pharmacology Department, Nantes University Hospital, Nantes 44000, France
| | - Éric Batard
- Cibles et médicaments des infections et de l'immunité, IICiMed, UR 1155, Nantes Université, Nantes 44000, France
- Emergency department, Nantes University Hospital, Nantes 44000, France
| | - François Javaudin
- Cibles et médicaments des infections et de l'immunité, IICiMed, UR 1155, Nantes Université, Nantes 44000, France
- Emergency department, Nantes University Hospital, Nantes 44000, France
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Cekin ZK, Oncul A, Bayraktar B. Bloodstream Infections Caused by Multidrug Resistant Bacteria: Clinical and Microbiological Features and Mortality. SISLI ETFAL HASTANESI TIP BULTENI 2023; 57:416-425. [PMID: 37900327 PMCID: PMC10600613 DOI: 10.14744/semb.2023.31697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/16/2023] [Accepted: 07/31/2023] [Indexed: 10/31/2023]
Abstract
Objectives Bloodstream infections (BSI) are associated with high morbidity and mortality. The aim of our study is to determine whether there is a relationship between certain risk factors such as the underlying disease, patient's medical history, or interventional procedures and multidrug resistant (MDR) bacterial infection and to determine the risk factors for mortality. Methods Two hundred and twenty-two outpatients and inpatients who were diagnosed with bacteremia over a 6-month period were included in the study. 232 agents from 222 patients were isolated and tested for antimicrobial susceptibility. The relationship between patients demographic and clinical data and MDR was analyzed. Results The most common microorganisms were Gram-negative bacteria (59.4%), Gram-positive bacteria (36.9%), Candida species (2.2%), and anaerobic bacteria (1.35%). The most common isolates were Escherichia coli 53 (22.8%), Staphylococcus aureus 35 (%15.1), Klebsiella pneumoniae 26 (11.2%), Pseudomonas spp. (n=17, 7.3%), Acinetobacter spp 17 (7.3%), and Enterococcus spp 14 (6%). Microorganisms with the highest antimicrobial resistance observed were 82.3% in Acinetobacter baumannii, 64.5% in coagulase-negative staphylococci, 60.3% in E. coli, 50% in K. pneumoniae, and 27.2% in Enterobacterales spp. Most patients with BSI caused by MDR bacteria were in the intensive care unit (64%). Sepsis diagnosis, urinary catheter use, history of surgery, and use of broad-spectrum antibiotics as well as risk factors for antibiotic-resistant bacteremia, coronary artery disease, inappropriate empirical therapy, healthcare-associated infections, urinary catheterization, and stay in the ICU were determined as risk factors for mortality. Conclusion Our study identified the risk factors of BSI caused by MDR bacteria and helped to reveal the relationship between these factors and mortality.
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Affiliation(s)
- Zuhal Kalayci Cekin
- Clinical Microbiology Laboratory, Bolu Izzet Baysal State Hospital, Bolu, Türkiye
| | - Ahsen Oncul
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Banu Bayraktar
- Department of Clinical Microbiology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
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10
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Kiros T, Belete D, Andualem T, Workineh L, Tilahun M, Eyayu T, Getie B, Tiruneh T, Kiflom S, Damtie S, Gebreyesus T. Carriage of β-lactamase and carbapenemase-producing Enterobacteriaceae in hospitalized patients at debre tabor comprehensive specialized hospital. Heliyon 2023; 9:e20072. [PMID: 37809731 PMCID: PMC10559802 DOI: 10.1016/j.heliyon.2023.e20072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
Background Antimicrobial resistance has remained global public health threat. Carriage with drug-resistant bacterial pathogens, particularly beta-lactamase and carbapenemase-producing Enterobacteriaceae is among the most concerning. The purpose of this study was to look into the magnitude, antimicrobial resistance patterns, and associated risk factors among hospitalized patients. Methods A facility-based cross-sectional study was conducted on 383 hospitalized patients at Debre Tabor Comprehensive Specialized Hospital between September 2022 and May 2023. A pre-tested structured questionnaire was used to collect sociodemographic and clinical data. The data on the etiologic agent was collected using standard bacteriological techniques. Briefly, stool specimens were collected aseptically into sterile, leak-proof stool cups. The stool sample was inoculated onto MacConkey agar and incubated aerobically at 37 °C for 24 h. The species isolation and antimicrobial resistance patterns were then performed adhering to bacteriological procedures. In the analysis, a p-value of <0.05 was considered statistically significant. Results There were 383 study participants, and men made up the majority (55.6%). The study participants' mean age was 33 ± 18 years. Three hundred and seventy-seven (88%) of the study's participants had no previous history of antibiotic use. There were 102 (26.6%) and 21 (5.5%) cases of gastrointestinal carriage caused by Enterobacteriaceae that produce beta-lactamase and carbapenemase, respectively. In total, 175 isolates of Enterobacteriaceae were detected. E. coli (n = 89) and K. pneumoniae (n = 51) were the most frequently recovered. In this study, 46 (79.3%) and 8 (13.8%) isolates of E. coli that produce beta-lactamase were resistant to ampicillin and amoxicillin/clavulanic acid, respectively. Furthermore, participants who had previously used antibiotics experienced a two-fold increase in exposure to gastrointestinal tract carriage by carbapenemase-producing Enterobacteriaceae [AOR, 95% CI (2.01, 1.06-2.98), p = 0.001]. Conclusions The emergence of drug-resistant pathogens is a growing concern. An increase in the prevalence of drug-resistant infections in hospitalized patients is warranting further investigation.
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Affiliation(s)
- Teklehaimanot Kiros
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Debaka Belete
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfaye Andualem
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Lemma Workineh
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mekdes Tilahun
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tahir Eyayu
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Birhanu Getie
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tegenaw Tiruneh
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Saymon Kiflom
- College of Natural and Computational Sciences, Mekelle University, Mekelle, Ethiopia
| | - Shewaneh Damtie
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
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Raffelsberger N, Buczek DJ, Svendsen K, Småbrekke L, Pöntinen AK, Löhr IH, Andreassen LLE, Simonsen GS, Sundsfjord A, Gravningen K, Samuelsen Ø. Community carriage of ESBL-producing Escherichia coli and Klebsiella pneumoniae: a cross-sectional study of risk factors and comparative genomics of carriage and clinical isolates. mSphere 2023; 8:e0002523. [PMID: 37306968 PMCID: PMC10470604 DOI: 10.1128/msphere.00025-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/05/2023] [Indexed: 06/13/2023] Open
Abstract
The global prevalence of infections caused by extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) is increasing, and for Escherichia coli, observations indicate that this is partly driven by community-onset cases. The ESBL-E population structure in the community is scarcely described, and data on risk factors for carriage are conflicting. Here, we report the prevalence and population structure of fecal ESBL-producing E. coli and Klebsiella pneumoniae (ESBL-Ec/Kp) in a general adult population, examine risk factors, and compare carriage isolates with contemporary clinical isolates. Fecal samples obtained from 4,999 participants (54% women) ≥40 years in the seventh survey of the population-based Tromsø Study, Norway (2015, 2016), were screened for ESBL-Ec/Kp. In addition, we included 118 ESBL-Ec clinical isolates from the Norwegian surveillance program in 2014. All isolates were whole-genome sequenced. Risk factors associated with carriage were analyzed using multivariable logistic regression. ESBL-Ec gastrointestinal carriage prevalence was 3.3% [95% confidence interval (CI) 2.8%-3.9%, no sex difference] and 0.08% (0.02%-0.20%) for ESBL-Kp. For ESBL-Ec, travel to Asia was the only independent risk factor (adjusted odds ratio 3.46, 95% CI 2.18-5.49). E. coli ST131 was most prevalent in both collections. However, the ST131 proportion was significantly lower in carriage (24%) versus clinical isolates (58%, P < 0.001). Carriage isolates were genetically more diverse with a higher proportion of phylogroup A (26%) than clinical isolates (5%, P < 0.001), indicating that ESBL gene acquisition occurs in a variety of E. coli lineages colonizing the gut. STs commonly related to extraintestinal infections were more frequent in clinical isolates also carrying a higher prevalence of antimicrobial resistance, which could indicate clone-associated pathogenicity.IMPORTANCEESBL-Ec and ESBL-Kp are major pathogens in the global burden of antimicrobial resistance. However, there is a gap in knowledge concerning the bacterial population structure of human ESBL-Ec/Kp carriage isolates in the community. We have examined ESBL-Ec/Kp isolates from a population-based study and compared these to contemporary clinical isolates. The large genetic diversity of carriage isolates indicates frequent ESBL gene acquisition, while those causing invasive infections are more clone dependent and associated with a higher prevalence of antibiotic resistance. The knowledge of factors associated with ESBL carriage helps to identify patients at risk to combat the spread of resistant bacteria within the healthcare system. Particularly, previous travel to Asia stands out as a major risk factor for carriage and should be considered in selecting empirical antibiotic treatment in critically ill patients.
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Affiliation(s)
- Niclas Raffelsberger
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- Department of Medical Biology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Dorota Julia Buczek
- Department of Medical Biology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Kristian Svendsen
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Lars Småbrekke
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anna Kaarina Pöntinen
- Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Iren H. Löhr
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | | | - Gunnar Skov Simonsen
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- Department of Medical Biology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Norwegian E. coli ESBL Study Group
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- Department of Medical Biology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- Department of Biostatistics, University of Oslo, Oslo, Norway
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
- Department of Microbiology and Infection Control, Akershus University Hospital, Nordbyhagen, Norway
- Division of Medicine and Laboratory Sciences, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Arnfinn Sundsfjord
- Department of Medical Biology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - Kirsten Gravningen
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- Department of Microbiology and Infection Control, Akershus University Hospital, Nordbyhagen, Norway
- Division of Medicine and Laboratory Sciences, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ørjan Samuelsen
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
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12
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Saeed MA, Saqlain M, Waheed U, Ehtisham-Ul-Haque S, Khan AU, Rehman AU, Sajid M, Atif FA, Neubauer H, El-Adawy H. Cross-Sectional Study for Detection and Risk Factor Analysis of ESBL-Producing Avian Pathogenic Escherichia coli Associated with Backyard Chickens in Pakistan. Antibiotics (Basel) 2023; 12:antibiotics12050934. [PMID: 37237837 DOI: 10.3390/antibiotics12050934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
The increasing incidence of extended-spectrum β-lactamase (ESBL)-producing Escherichia (E.) coli in backyard chicken farming in Pakistan is of serious concern. This study aimed to assess the prevalence, antimicrobial resistance patterns and risk factors associated with ESBL avian pathogenic E. coli (APEC) isolated from backyard chickens in the Jhang district, Punjab, Pakistan. In total, 320 cloacal swabs were collected from four breeds of backyard chicken (Aseel, Golden, Misri and Necked Neck). ESBL E. coli were phenotypically identified using double disc synergy test (DDST) and corresponding genes were confirmed by multiplex polymerase chain reaction (mPCR). Out of the 320 samples, 164 (51.3%) were confirmed as E. coli, while 74 (45.1%) were characterized as ESBL E. coli. The frequency of isolation of ESBL E. coli was highest in Aseel chickens (35.1%). Of the 164 confirmed E. coli, 95.1%, 78.6%, 76.8%, 71.3%, 70.1%, 68.9%, 60.4% and 57.3% were resistant against tylosin, doxycycline, cefotaxime, enrofloxacin, colistin, trimethoprim/sulfamethoxazole, chloramphenicol and gentamicin, respectively. The ESBL gene types detected and their corresponding proportions were blaCTX-M (54.1 %, 40/74), blaTEM, (12.2%, 9/74) and co-existence (blaCTX-M and blaTEM) were shown in 33.8% (25/74). The blaCTX-M gene sequence showed homology to blaCTX-M-15 from clinical isolates. The mean multiple antibiotic resistance index (MARI) was found to be higher among ESBL E. coli (0.25) when compared to non-ESBL E. coli (0.17). Both free-range husbandry management system (p = 0.02, OR: 30.00, 95% CI = 1.47-611.79) and high antimicrobial usage in the last 6 months (p = 0.01, OR: 25.17, 95% CI = 1.81-348.71) were found significantly associated with isolation of ESBL-producing E. coli in the tested samples using binary logistic regression analysis. This study confirmed the potential of backyard chickens as a reservoir for ESBL E. coli in the Jhang district, Punjab, Pakistan.
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Affiliation(s)
- Muhammad Adnan Saeed
- Department of Pathobiology, University of Veterinary and Animal Sciences, Lahore, CVAS Campus, 12-Km Chiniot Road, Jhang 35200, Pakistan
| | - Muhammad Saqlain
- Department of Pathobiology, University of Veterinary and Animal Sciences, Lahore, CVAS Campus, 12-Km Chiniot Road, Jhang 35200, Pakistan
| | - Usman Waheed
- Department of Pathobiology, University of Veterinary and Animal Sciences, Lahore, CVAS Campus, 12-Km Chiniot Road, Jhang 35200, Pakistan
| | - Syed Ehtisham-Ul-Haque
- Department of Pathobiology, University of Veterinary and Animal Sciences, Lahore, CVAS Campus, 12-Km Chiniot Road, Jhang 35200, Pakistan
| | - Aman Ullah Khan
- Department of Pathobiology, University of Veterinary and Animal Sciences, Lahore, CVAS Campus, 12-Km Chiniot Road, Jhang 35200, Pakistan
| | - Aziz Ur Rehman
- Department of Pathobiology, University of Veterinary and Animal Sciences, Lahore, CVAS Campus, 12-Km Chiniot Road, Jhang 35200, Pakistan
| | - Muhammad Sajid
- Department of Pathobiology, University of Veterinary and Animal Sciences, Lahore, CVAS Campus, 12-Km Chiniot Road, Jhang 35200, Pakistan
| | - Farhan Ahmad Atif
- Department of Clinical Sciences, University of Veterinary and Animal Sciences, Lahore, CVAS Campus, 12-Km Chiniot Road, Jhang 35200, Pakistan
| | - Heinrich Neubauer
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut, 07743 Jena, Germany
| | - Hosny El-Adawy
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut, 07743 Jena, Germany
- Faculty of Veterinary Medicine, Kafrelsheikh University, Kafr El-Sheikh 35516, Egypt
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13
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Impact of COVID-19 pandemic on multidrug resistant gram positive and gram negative pathogens: A systematic review. J Infect Public Health 2023; 16:320-331. [PMID: 36657243 PMCID: PMC9804969 DOI: 10.1016/j.jiph.2022.12.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND There is paucity of data describing the impact of COVID-19 pandemic on antimicrobial resistance. This review evaluated the changes in the rate of multidrug resistant gram negative and gram positive bacteria during the COVID-19 pandemic. METHODS A search was conducted in PubMed, Science Direct, and Google Scholar databases to identify eligible studies. Studies that reported the impact of COVID-19 pandemic on carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Enterobacteriaceae (CRE), extended-spectrum beta-lactamase inhibitor (ESBL)-producing Enterobacteriaceae, vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Pseudomonas aeruginosa (CPE) were selected. Studies published in English language from the start of COVID-19 pandemic to July 2022 were considered for inclusion. RESULTS Thirty eligible studies were selected and most of them were from Italy (n = 8), Turkey (n = 3) and Brazil (n = 3). The results indicated changes in the rate of multidrug resistant bacteria, and the changes varied between the studies. Most studies (54.5%) reported increase in MRSA infection/colonization during the pandemic, and the increase ranged from 4.6 to 170.6%. Five studies (55.6%) reported a 6.8-65.1% increase in VRE infection/colonization during the pandemic. A 2.4-58.2% decrease in ESBL E. coli and a 1.8-13.3% reduction in ESBL Klebsiella pneumoniae was observed during the pandemic. For CRAB, most studies (58.3%) reported 1.5-621.6% increase in infection/colonization during the pandemic. Overall, studies showed increase in the rate of CRE infection/colonization during the pandemic. There was a reduction in carbapenem-resistant E. coli during COVID-19 pandemic, and an increase in carbapenem-resistant K. pneumoniae. Most studies (55.6%) showed 10.4 - 40.9% reduction in the rate of CRPA infection during the pandemic. CONCLUSION There is an increase in the rate of multidrug resistant gram positive and gram negative bacteria during the COVID-19 pandemic. However, the rate of ESBL-producing Enterobacteriaceae and CRPA has decrease during the pandemic. Both infection prevention and control strategies and antimicrobial stewardship should be strengthen to address the increasing rate of multidrug resistant gram positive and gram negative bacteria.
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14
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Dohmen W, Liakopoulos A, Bonten MJM, Mevius DJ, Heederik DJJ. Longitudinal Study of Dynamic Epidemiology of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli in Pigs and Humans Living and/or Working on Pig Farms. Microbiol Spectr 2023; 11:e0294722. [PMID: 36648229 PMCID: PMC9927210 DOI: 10.1128/spectrum.02947-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/01/2022] [Indexed: 01/18/2023] Open
Abstract
Extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales have been increasingly isolated from pigs, highlighting their potential for transmission to humans living and/or working within pig farms. As longitudinal data on the prevalence and the molecular characteristics of such isolates from the high-risk farming population remain scarce, we performed a long-term study on 39 Dutch pig farms. Fecal samples from pigs, farmers, family members, and employees were collected during four sampling occasions with a 6-month period. The presence of ESBL-producing Enterobacterales and their molecular characteristics (ESBL gene, plasmid, and sequence types) were determined by standard methods. Data on personal and farm characteristics were collected using questionnaires. ESBL-producing Escherichia coli was present in pigs at least once for 18 of 39 farms and in 17 of 146 farmers, family members, and/or employees. Among these 417 E. coli isolates, blaCTX-M-1 was the most frequently observed ESBL gene in pigs (n = 261) and humans (n = 25). Despite the great variety in plasmid (sub)types and E. coli sequence types (STs), we observed genetic similarity between human- and pig-derived isolates in (i) ESBL gene, plasmid (sub)type, and ST, suggesting potential clonal transmission in seven farms, and (ii) only ESBL gene and plasmid (sub)type, highlighting the possibility of horizontal transfer in four farms. Five pig farmers carried ESBL producers repeatedly, of whom two carried an identical combination of gene, plasmid (sub)type, and ST over time. Human ESBL carriage was associated with both presence of ESBL producers in pigs and average number of hours working on the pig farm per week, while prolonged human carriage was observed only incidentally. IMPORTANCE Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli represents a public health hazard due to reduced therapeutic options for the treatment of infections. Although direct contact with pigs is considered a risk factor for human ESBL-producing E. coli carriage through occupational exposure, nationwide data regarding the occurrence of such isolates among pigs and humans living and/or working on farms remain scarce. Therefore, we determined (i) the longitudinal dynamics in prevalence and molecular characteristics of ESBL-producing E. coli in Dutch pig farmers and their pigs over time and (ii) the potential transmission events between these reservoirs based on genetic relatedness and epidemiological associations in longitudinal data. Our data suggesting the possibility of clonal and horizontal dissemination of ESBL-producing Escherichia coli between pigs and pig farmers can be used to inform targeted intervention strategies to decrease the within-farm human exposure to ESBL-producing E. coli.
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Affiliation(s)
- Wietske Dohmen
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Apostolos Liakopoulos
- Department of Bacteriology and Epidemiology, Wageningen Bioveterinary Research, Lelystad, The Netherlands
| | - Marc J. M. Bonten
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dik J. Mevius
- Department of Bacteriology and Epidemiology, Wageningen Bioveterinary Research, Lelystad, The Netherlands
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Dick J. J. Heederik
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
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15
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Obeng-Nkrumah N, Hansen DS, Awuah-Mensah G, Blankson NK, Frimodt-Møller N, Newman MJ, Opintan JA, Krogfelt KA. High level of colonization with 3rd-generation cephalosporin-resistant Enterobacterales in African community settings, Ghana. Diagn Microbiol Infect Dis 2023; 106:115918. [PMID: 37058979 DOI: 10.1016/j.diagmicrobio.2023.115918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/10/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
A cross-sectional survey was conducted in eight Ghanaian communities to investigate the extent of intestinal colonization with 3rd-generation cephalosporin-resistant Enterobacterales. The study collected faecal samples and corresponding lifestyle data from 736 healthy residents to assess the occurrence of cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae, with a focus on genotypes of plasmid-mediated ESBLs, AmpCs, and carbapenemases. The results showed that 371 participants (50.4%) carried 3rd-generation cephalosporin-resistant E. coli (n=362) and K. pneumoniae (n=9). Most of these were ESBL-producing E. coli (n=352, 94.9%), carrying CTX-M genes (96.0%, n=338/352), mostly for CTX-M-15 (98.9%, n=334/338). Nine participants (1.2%) carried AmpC-producing E. coli that harboured blaDHA-1 or blaCMY-2 genes, and two participants (0.3%) each carried a carbapenem-resistant E. coli that harboured both blaNDM-1 and blaCMY-2. Quinolone-resistant O25b: ST131 E. coli were recovered from six participants (0.8%) and were all CTX-M-15 ESBL-producers. Having a household toilet facility was significantly associated with a reduced risk of intestinal colonization (adjusted odds ratio, 0.71; 95% CI, 0.48-0.99; P-value=0.0095) in multivariate analysis. These findings raise serious public health concerns, and effective control of the spread of antibiotic-resistant bacteria is possible by providing better sanitary conditions for communities.
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Affiliation(s)
- Noah Obeng-Nkrumah
- Department of Medical Laboratory Sciences, University of Ghana School of Biomedical and Allied Health Sciences, University of Ghana, Legon, Accra, Ghana.
| | | | - Georgina Awuah-Mensah
- School of Life Sciences Medical School, Queen's Medical Centre, University of Nottingham, Nottingham England
| | - Nana Kweiba Blankson
- Department of Microbiological diagnostics, Statens Serum Institut, Copenhagen Denmark
| | - Niels Frimodt-Møller
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Mercy Jemima Newman
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Legon, Accra, Ghana
| | - Japheth Awuletey Opintan
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Legon, Accra, Ghana
| | - Karen Angeliki Krogfelt
- Department of Science and Environment, Pandemix Center Roskilde University, Roskilde, Denmark.
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Piotrowska MJ, Sakowski K, Horn J, Mikolajczyk R, Karch A. The effect of re-directed patient flow in combination with targeted infection control measures on the spread of multi-drug-resistant Enterobacteriaceae in the German health-care system: a mathematical modelling approach. Clin Microbiol Infect 2023; 29:109.e1-109.e7. [PMID: 35970445 DOI: 10.1016/j.cmi.2022.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/27/2022] [Accepted: 08/03/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The introduction of multi-drug-resistant Enterobacteriaceae (MDR-E) by colonized patients transferred from high-prevalence countries has led to several large outbreaks of MDR-E in low-prevalence countries, with the risk of propagated spread to the community. The goal of this study was to derive a strategy to counteract the spread of MDR-E at the regional health-care network level. METHODS We used a hybrid ordinary differential equation and network model built based on German health insurance data to evaluate whether the re-direction of patient flow in combination with targeted infection control measures can counteract the spread of MDR-E in the German health-care system. We applied pragmatic re-direction strategies focusing on a reduced choice of hospitals for subsequent stays after initial hospitalization but not manipulating direct transfers because these are most likely determined by medical needs. RESULTS The re-direction strategies alone did not reduce the system-wide spread of MDR-E (system-wide prevalence of MDR-E is 18.7% vs. 25.7%/29.9%). In contrast, targeted hospital-based infection control measures restricted to institutions with the highest institutional basic reproduction numbers in the network were identified as an effective tool for reducing system-wide prevalence (system-wide prevalence of MDR-E is 18.7% vs. 9.3%). If these measures were applied to the top one-third of hospitals, the system-wide prevalence could be reduced by approximately 80% (system-wide prevalence of 18.7% vs. 3.5% for one-third of patients subjected to interventions). A combination of this hospital-based intervention and patient re-direction strategies could not improve the effectiveness of the hospital-based approach (system-wide prevalence of MDR-E is 9.3% vs. 14.2%/14.3%). CONCLUSIONS The pragmatic patient re-direction strategies were not capable of restricting the spread of MDR-E in a simulation of the German health-care system; in contrast, hospital-based interventions focusing on institutions identified based on network transmission patterns seem to be a promising approach for sustainable reduction of the spread of MDR-E through the German population.
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Affiliation(s)
- Monika J Piotrowska
- Institute of Applied Mathematics and Mechanics, University of Warsaw, Poland
| | - Konrad Sakowski
- Institute of Applied Mathematics and Mechanics, University of Warsaw, Poland.
| | - Johannes Horn
- Institute for Medical Epidemiology, Biometrics, and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics, and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - André Karch
- Institute of Epidemiology and Social Medicine, University of Münster, Germany
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17
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Voor in ’t holt AF, van der Schoor AS, Mourik K, Strepis N, Klaassen CHW, Vos MC, Severin JA. Pre-COVID-19 international travel and admission to hospital when back home: travel behavior, carriage of highly resistant microorganisms, and risk perception of patients admitted to a large tertiary care hospital. Antimicrob Resist Infect Control 2022; 11:78. [PMID: 35655236 PMCID: PMC9161189 DOI: 10.1186/s13756-022-01106-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background When people who recently travelled abroad are admitted to a hospital back home, there is a risk of introducing highly resistant microorganisms (HRMO) into the hospital. To minimize this risk, a feasible infection prevention strategy should be developed. In this study, we investigated patients’ travel history and behavior during travel and analyzed whether this was correlated to HRMO carriage at admission. Methods From May 2018 until August 2019, adult patients admitted to a large tertiary care center in the Netherlands were asked upon hospital admission to participate in the study. Included patients received a questionnaire about risk perception, travel history in the last year, and behavior during travel, and were screened for HRMO carriage at admission using a perianal swab. Results Six hundred and eight questionnaires were handed out, of which 247 were returned (40.6%). One hundred and thirty (52.6%) patients did not travel abroad in the last year, of whom eight (6.2%) were HRMO carrier at admission. One hundred seventeen (47.4%) patients travelled in the preceding year, of whom seven patients (6.0%) were HRMO carrier at admission. Thirty patients (12%) travelled outside of Europe; in this group HRMO prevalence was 13.3% (4 out of 30). The majority of patients (71.3%) were aware that international travel could lead to carriage of HRMO, and an even larger majority (89.5%) would support a screening strategy upon hospital admission in case of a travel history, to minimize the risk of introducing HRMO. Conclusions We identified that half of admitted patients to a large tertiary care hospital travelled abroad in the last year, with only a small percentage outside Europe. We discuss several screening strategies and propose a strategy of screening and preemptive isolation of patients who travelled to Asia or Africa in the 2 months before their hospital admission; a strategy that patients would support. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01106-x.
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18
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Ham SY, Jung H, Song KH, Jeong H, Jung J, Moon SM, Park JS, Kim NH, Jang ES, Kim JW, Jeong SH, Kim ES, Kim HB. Interspecies differences in clinical characteristics and risk factors for third-generation cephalosporin resistance between Escherichia coli and Klebsiella pneumoniae bloodstream infection in patients with liver cirrhosis. Eur J Clin Microbiol Infect Dis 2022; 41:1459-1465. [PMID: 36227508 DOI: 10.1007/s10096-022-04508-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/07/2022] [Indexed: 11/30/2022]
Abstract
This retrospective study aimed to clarify the interspecies differences in the clinical characteristics and risk factors of bloodstream infection (BSI) due to third-generation cephalosporin-resistant (3GC-R) Escherichia coli (EC) and Klebsiella pneumoniae (KP) in patients with liver cirrhosis (LC). KP BSI had more comorbidities and higher treatment failure rate than EC BSI. Non-alcoholic LC was a risk factor for treatment failure in EC, whereas it was not associated with KP. Risk factors for BSI due to 3GC-R strain were nosocomial infection in EC, and β-lactam/fluoroquinolone treatment ≤ 30 days in KP. These results could help predict outcomes of BSI and improve clinical practice.
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Affiliation(s)
- Sin Young Ham
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea.,Department of Internal Medicine, Korea Veterans Hospital, Seoul, the Republic of Korea
| | - Hyungul Jung
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea
| | - Kyoung-Ho Song
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, the Republic of Korea
| | - Hyeonju Jeong
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea
| | - Jongtak Jung
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea
| | - Song Mi Moon
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, the Republic of Korea
| | - Jeong Su Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, the Republic of Korea
| | - Nak-Hyun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea
| | - Eun Sun Jang
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, the Republic of Korea
| | - Jin-Wook Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, the Republic of Korea
| | - Sook-Hyang Jeong
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, the Republic of Korea
| | - Eu Suk Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea. .,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, the Republic of Korea.
| | - Hong Bin Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, the Republic of Korea
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19
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Habibzadeh N, Peeri Doghaheh H, Manouchehri Far M, Alimohammadi Asl H, Iranpour S, Arzanlou M. Fecal Carriage of Extended-Spectrum β-Lactamases and pAmpC Producing Enterobacterales in an Iranian Community: Prevalence, Risk Factors, Molecular Epidemiology, and Antibiotic Resistance. Microb Drug Resist 2022; 28:921-934. [PMID: 36067095 DOI: 10.1089/mdr.2021.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study aimed to determine the prevalence and risk factors associated with intestinal carriage of extended-spectrum β-lactamases producing Enterobacterales (ESBL-PE) and plasmid-mediated AmpC β-lactamase producing Enterobacterales (AmpC-PE) in healthy children in Ardabil, Iran. A total of 305 fecal samples were collected. Isolates underwent antimicrobial susceptibility testing, phenotypic and genotypic identification of β-lactamase production, and epidemiologic molecular typing. In total, 21.5%, 1.5%, and 1.2% of volunteers were extended-spectrum β-lactamase (ESBL)-, AmpC-, and simultaneous ESBL/AmpC-PE carriers, respectively. Escherichia coli was the predominant ESBL producing bacterium (70.2%) found in ESBL-PE colonized subjects. Beyond ESBL positive isolates, bla CTX-M group genes were the most common type (75.6%) and bla TEM (non-bla TEM-1 and non- bla TEM-2) were in the second place (25.6%). Among bla CTX-M genes, bla CTX-M-1 (55.3%) and bla CTX-M-15 (55.3%) were the most predominant types with equal prevalence. Some isolates were multi-enzyme producers. bla CIT and bla DHA genes were common AmpC type enzyme encoding genes found in AmpC-PE isolates. Most isolates produced both enzymes at the same time. The number of students in the classes was statistically associated with ESBL-PE intestinal carriage (p < 0.05). Moreover, 46 (65.7%), 3 (60%), 4 (100%), and 98 (39.8%) ESBL-, AmpC-, ESBL/AmpC, and non-ESBL/AmpC-PE isolates were multidrug-resistant, respectively. Overall, regardless of β-lactam antibiotics, 62% and 59.5% of isolates were resistant to co-trimoxazole and tetracycline, respectively. The majority of ESBL producing E. coli isolates (69.2%) belonged to phylogroup A. According to Enterobacterial repetitive intergenic consensus polymerase chain reaction, there was no clonal relatedness between isolates. This study showed a high rate of multi-resistant ESBL-PE intestinal carriage among healthy individuals in Iran.
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Affiliation(s)
- Nasrin Habibzadeh
- Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hadi Peeri Doghaheh
- Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Meysam Manouchehri Far
- Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hossein Alimohammadi Asl
- Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Sohrab Iranpour
- Department of Community Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mohsen Arzanlou
- Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
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20
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Arieti F, Savoldi A, Rejendran NB, Sibani M, Tebon M, Pezzani MD, Gorska A, Wozniak TM, Tacconelli E. The antimicrobial resistance travel tool, an interactive evidence-based educational tool to limit antimicrobial resistance spread. J Travel Med 2022; 29:6554586. [PMID: 35348740 PMCID: PMC9282094 DOI: 10.1093/jtm/taac045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND International travel has been recognized as a risk factor contributing to the spread of antimicrobial resistance (AMR). However, tools focused on AMR in the context of international travel and designed to guide decision-making are limited. We aimed at developing an evidence-based educational tool targeting both healthcare professionals (HCPs) and international travellers to help prevent the spread of AMR. METHODS A literature review on 12 antimicrobial-resistant bacteria (ARB) listed as critical and high tiers in the WHO Pathogen Priority List covering four key areas was carried out: AMR surveillance data; epidemiological studies reporting ARB prevalence data on carriage in returning travellers; guidance documents reporting indications on screening for ARB in returning travellers and recommendations for ARB prevention for the public. The evidence, catalogued at country-level, provided the content for a series of visualizations that allow assessment of the risk of AMR acquisition through travel. RESULTS Up to January 2021, the database includes data on: (i) AMR surveillance for 2.018.241 isolates from 86 countries; (ii) ARB prevalence of carriage from 11.679 international travellers and (iii) 15 guidance documents published by major public health agencies. The evidence allowed the development of a consultation scheme for the evaluation of risk factors, prevalence of carriage, proportion and recommendations for screening of AMR. For the public, pre-travel practical measures to minimize the risk of transmission were framed. CONCLUSIONS This easy-to-use, annually updated, freely accessible AMR travel tool (https://epi-net.eu/travel-tool/overview/), is the first of its kind to be developed. For HCPs, it can provide a valuable resource for teaching and a repository that facilitates a stepwise assessment of the risk of AMR spread and strengthen implementation of optimized infection control measures. Similarly, for travellers, the tool has the potential to raise awareness of AMR and outlines preventive measures that reduce the risk of AMR acquisition and spread.
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Affiliation(s)
- Fabiana Arieti
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona 37134, Italy
| | - Alessia Savoldi
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona 37134, Italy
| | - Nithya Babu Rejendran
- Division of Infectious Diseases, Department of Internal Medicine I, German Center for Infection Research, University of Tübingen, Tübingen 72074, Germany.,German Centre for Infection Research (DZIF), Clinical Research Unit for Healthcare Associated Infections, Tübingen 72074, Germany
| | - Marcella Sibani
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona 37134, Italy
| | - Maela Tebon
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona 37134, Italy
| | - Maria Diletta Pezzani
- Division of Infectious Diseases, Department of Medicine, Verona University Hospital, Verona 37134, Italy
| | - Anna Gorska
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona 37134, Italy
| | - Teresa M Wozniak
- Menzies School of Health Research, Charles Darwin University, Darwin 8100, Northern Territory, Australia.,Australian e-Health Research Centre CSIRO, Brisbane 4000, Qeensland Australia
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona 37134, Italy.,Division of Infectious Diseases, Department of Internal Medicine I, German Center for Infection Research, University of Tübingen, Tübingen 72074, Germany.,German Centre for Infection Research (DZIF), Clinical Research Unit for Healthcare Associated Infections, Tübingen 72074, Germany
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21
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van der Schoor AS, Severin JA, van der Weg AS, Strepis N, Klaassen CHW, van den Akker JPC, Bruno MJ, Hendriks JM, Vos MC, Voor In 't Holt AF. The effect of 100% single-occupancy rooms on acquisition of extended-spectrum beta-lactamase-producing Enterobacterales and intra-hospital patient transfers: a prospective before-and-after study. Antimicrob Resist Infect Control 2022; 11:76. [PMID: 35655322 PMCID: PMC9164559 DOI: 10.1186/s13756-022-01118-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) are a well-known cause of healthcare-associated infections. The implementation of single-occupancy rooms is believed to decrease the spread of ESBL-E. Additionally, implementation of single-occupancy rooms is expected to reduce the need for intra-hospital patient transfers. We studied the impact of a new hospital with 100% single-occupancy rooms on the acquisition of ESBL-E and on intra-hospital patient transfers. METHODS In 2018, the Erasmus MC University Medical Center moved from an old, 1200-bed hospital with mainly multiple-occupancy rooms, to a newly constructed 522-bed hospital with 100% single-occupancy rooms. Adult patients admitted between January 2018 and September 2019 with an expected hospitalization of ≥ 48 h were asked to participate in this study. Perianal samples were taken at admission and discharge. Patient characteristics and clinical information, including number of intra-hospital patient transfers, were collected from the patients' electronic health records. RESULTS Five hundred and ninety-seven patients were included, 225 in the old and 372 in the new hospital building. Fifty-one (8.5%) ESBL-E carriers were identified. Thirty-four (66.7%) patients were already positive at admission, of which 23 without recent hospitalization. Twenty patients acquired an ESBL-E, seven (3.1%) in the old and 13 (3.5%) in the new hospital building (P = 0.801). Forty-one (80.4%) carriers were only detected by the active screening performed during this study. Only 10 (19.6%) patients, six before and four during hospitalization, showed ESBL-E in a clinical sample taken on medical indication. Fifty-six (24.9%) patients were transferred to other rooms in the old hospital, compared to 53 (14.2%) in the new hospital building (P = 0.001). Intra-hospital patient transfers were associated with ESBL-E acquisition (OR 3.18, 95%CI 1.27-7.98), with increasing odds when transferred twice or more. CONCLUSION Transitioning to 100% single-occupancy rooms did not decrease ESBL-E acquisition, but did significantly decrease the number of intra-hospital patient transfers. The latter was associated with lower odds on ESBL-E acquisition. ESBL-E carriers remained largely unidentified through clinical samples. TRIAL REGISTRATION This study was retrospectively registered in the Dutch National Trial Register on 24-02-2020, with registration number NL8406.
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Affiliation(s)
- Adriënne S van der Schoor
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Juliëtte A Severin
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anna S van der Weg
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Nikolaos Strepis
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Corné H W Klaassen
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Johanna M Hendriks
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anne F Voor In 't Holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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22
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Patjas A, Kantele A. International travel and travelers' diarrhea - Increased risk of urinary tract infection. Travel Med Infect Dis 2022; 48:102331. [PMID: 35447322 DOI: 10.1016/j.tmaid.2022.102331] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Urinary tract infections (UTIs) rank among the most common infections encountered in health care, with an annual incidence of 12% for women. Despite the vast numbers of international travels (over 1.5 billion annually), no prospective studies have had primary focus on UTIs during travel. METHODS We recruited in 2008-17 international travelers who all filled out pre- and post-travel questionnaires. Incidence rates of UTI were calculated separately for both sexes. Multivariable analyses were conducted to identify risk factors for UTI during travel. RESULTS In total 15/517 (2,9%) travelers acquired UTI during travel, yielding an annual incidence of 62% for female and 18% for male travelers. Travelers' diarrhea (TD) was identified as a factor predisposing to UTI (OR 9.2, 95% CI 1.5-+∞, p = 0.011); all UTI cases were recorded by travelers with TD. CONCLUSIONS To our knowledge, this is the first prospective study with a primary focus on UTI during travel. Our data reveal that among travelers the incidence of UTI far exceeds that reported for the general population. TD was identified as a major risk factor for the infection. Our results highlight the need for TD prevention as a means of also preventing UTI during travel.
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Affiliation(s)
- Anu Patjas
- Meilahti Infectious Diseases and Vaccine Research Center, MeiVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, P.O. Box 700, FI-00029, HUS, Helsinki, Finland; Human Microbiome Research Unit, University of Helsinki, Finland; Travel Clinic, Aava Medical Center, Annankatu 32, FI-00100, Helsinki, Finland; Center of Excellence in Antimicrobial Resistance Research, University of Helsinki, Finland
| | - Anu Kantele
- Meilahti Infectious Diseases and Vaccine Research Center, MeiVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, P.O. Box 700, FI-00029, HUS, Helsinki, Finland; Human Microbiome Research Unit, University of Helsinki, Finland; Travel Clinic, Aava Medical Center, Annankatu 32, FI-00100, Helsinki, Finland; Center of Excellence in Antimicrobial Resistance Research, University of Helsinki, Finland.
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23
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AbiGhosn J, AlAsmar M, Abboud E, Bailey BA, Haddad N. The Effect of Infection Precautions on Extended-Spectrum Beta-Lactamase Enterobacteriaceae Colonization Among Nurses in Three Beirut Hospitals. Cureus 2022; 14:e23849. [PMID: 35530839 PMCID: PMC9071177 DOI: 10.7759/cureus.23849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background and objective Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) are rapidly emerging worldwide. This study aimed to assess the effect of contact precaution (CP) on ESBL-PE-colonization rates among nurses in three hospitals in Beirut, Lebanon, where ESBL is endemic, in order to define the risk factors for colonization. Accordingly, the ongoing use of CP to prevent ESBL-PE transmission to healthy nurses was evaluated. Methods This cross-sectional study was conducted in three hospitals. Hospital 1 required CP, Hospital 2 had recently stopped CP, and Hospital 3 had stopped it three years previously. Questionnaires and stool-collection containers were distributed to all patient care nurses in those three hospitals. The Returned samples were tested using the agar dilution technique. Results A total of 269 out of 733 nurses volunteered to participate; 140 met the inclusion criteria (no recent hospitalization, antibiotic use, or known ESBL-PE colonization) and provided samples. Among them, 15% were ESBL-positive. Compared to nurses from Hospital 3, nurses from Hospital 1 were 59% less likely to be colonized, while nurses from Hospital 2 were 62% more likely to be colonized. Conclusion In hospitals where CP is in place for ESBL-positive patients, ESBL-PE prevalence in nursing staff was significantly lower. Additionally, a work experience of two to four years increased the odds of ESBL-PE colonization in comparison with longer nursing experience. CP may be a justifiable means of protection against ESBL-PE transmission to healthy nurses. The risk factors for colonization were discontinuation of CP and a shorter clinical work experience.
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Aghamohammad S, Nikbin VS, Badmasti F, Shahcheraghi F. High heterogeneity of fecal carriage extended-spectrum beta-lactamase-producing E. coli isolated from iranian community and clinical settings. BMC Infect Dis 2022; 22:318. [PMID: 35361158 PMCID: PMC8973555 DOI: 10.1186/s12879-022-07304-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/23/2022] [Indexed: 11/21/2022] Open
Abstract
Background Extended-spectrum beta-lactamase-producing enterobacteria (ESBL-PE) in carriers have become a global health problem. Using molecular typing techniques, including PFGE, could be useful to determine the source of bacterial dissemination. The current study aimed to investigate the intestinal carriage of ESBL-producing E. coli (ESBL-EC) and clonal relatedness among ESBL-EC isolated from hospitalized and outpatient fecal carriers in Iran. Methods A total of 120 rectal swabs were collected; 50.8% (61/120) from intensive care unit (ICU) inpatients and 49.2% (59/120) from outpatients. MacConkey agar enriched with cefotaxime was used to screen the ESBL-EC. PCR assays were performed to detect ESBL and carbapenemase genes. Pulse-fields gel electrophoresis (PFGE) was performed to assess clonal relatedness. Results Totally, 60.0% (72/120) were carrier for ESBL-EC. The rates of resistance against ceftazidime and cefepime were 90.2% (65/72) and 93.0% (67/72), respectively. The rates of blaCTX-M-15, blaTEM, blaSHV, blaNDM-1, blaOXA-48 and blaIMP was 90.2% (65/72), 50.0% (36/72), 5.5% (4/72), 4.1% (3/72), 4.1% (3/72) and 1.3% (1/72), respectively. Based on a cut-off 80%, 69 ESBL-EC isolates could be categorized in 10 mini-cluster and 47 isolates were considered as singletons. Discussion High heterogeneity among isolates from ESBL-EC suggests that this bacterium probably has a different source of dissemination. Screening of carriers in hospitals and communities could help the infection control program in public health. Supplementary information The online version contains supplementary material available at 10.1186/s12879-022-07304-7.
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Affiliation(s)
| | | | - Farzad Badmasti
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
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25
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Extended-Spectrum Beta-Lactamase- and Carbapenemase-Producing Enterobacteriaceae Family of Bacteria from Diarrheal Stool Samples in Northwest Ethiopia. Interdiscip Perspect Infect Dis 2022; 2022:7905350. [PMID: 35309500 PMCID: PMC8924597 DOI: 10.1155/2022/7905350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/24/2022] [Accepted: 02/01/2022] [Indexed: 11/24/2022] Open
Abstract
Background Resistance among the commensal flora is a serious threat because they are highly populated ecosystems like the gut, maybe a source of extraintestinal infections. Infections due to extended-spectrum beta-lactamase (ESBL)- and carbapenemase (CPM)-producing Enterobacteriaceae family of bacteria impose a major global issue because they are usually resistant to multiple antimicrobial agents. Data on the fecal ESBL- and CPM-producing group of bacteria in developing countries including Ethiopia are limited mainly due to resource constraints. Thus, this study aimed to determine the prevalence of multidrug-resistant (MDR)-, ESBL-, and CPM-producing Enterobacteriaceae family of bacteria from diarrheal stool samples at the University Hospital, Northwest Ethiopia. Materials and Methods A hospital-based cross-sectional study was conducted involving a total of 384 study participants having gastrointestinal complaints from January to April 2019. A diarrheal stool sample was aseptically collected and inoculated on a MacConkey agar plate. After getting pure colonies, biochemical and antimicrobial susceptibility testing was done following standard microbiological techniques. ESBL production was screened using ceftazidime and cefotaxime and confirmed using a combined disk diffusion test. Carbapenemases were screened by meropenem disk and confirmed by the modified carbapenem inactivation method. Data were checked, cleaned, and entered using Epi Info version 7.1 and transferred to SPSS version 20 for analysis. Result A total of 404 Enterobacteriaceae groups of bacteria were isolated from 384 diarrheal stool samples. The overall prevalence of fecal MDR-, ESBL-, and CPM-producing group of Enterobacteriaceae was 196 (48.5%), 66 (16.3%), and 4 (1%), respectively. Of the total ESBL-producing Enterobacteriaceae, E. coli (41/66 (62.1%)) and K. pneumoniae (18/66 (27.3%)) were the most predominant isolates. One half of CPE has been observed in Citrobacter species and the rest in E. coli (25%) and P. vulgaris (25%). Conclusion and Recommendation. Finding the high rate of ESBL-producing Enterobacteriaceae and CPE requires strict infection control measures and careful selection of empirical therapy in the study area. Therefore, active surveillance with large sample size and better infection prevention control is needed.
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Verelst M, Willemsen I, Weterings V, De Waegemaeker P, Leroux-Roels I, Nieuwkoop E, Saegeman V, van Alphen L, van Kleef-van Koeveringe S, Kluytmans-van den Bergh M, Kluytmans J, Schuermans A. Implementation of the Infection Risk Scan (IRIS) in nine hospitals in the Belgian-Dutch border region (i-4-1-Health project). Antimicrob Resist Infect Control 2022; 11:43. [PMID: 35227333 PMCID: PMC8887653 DOI: 10.1186/s13756-022-01083-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background A tool, the Infection Risk Scan has been developed to measure the quality of infection control and antimicrobial use. This tool measures various patient-, ward- and care-related variables in a standardized way. We describe the implementation of this tool in nine hospitals in the Dutch/Belgian border area and the obtained results.
Methods The IRIS consists of a set of objective and reproducible measurements: patient comorbidities, (appropriate) use of indwelling medical devices, (appropriate) use of antimicrobial therapy, rectal carriage of Extended-spectrum beta-lactamase producing Enterobacterales and their clonal relatedness, environmental contamination, hand hygiene performance, personal hygiene of health care workers and presence of infection prevention preconditions. The Infection Risk Scan was implemented by an expert team. In each setting, local infection control practitioners were trained to achieve a standardized implementation of the tool and an unambiguous assessment of data. Results The IRIS was implemented in 34 wards in six Dutch and three Belgian hospitals. The tool provided ward specific results and revealed differences between wards and countries. There were significant differences in the prevalence of ESBL-E carriage between countries (Belgium: 15% versus The Netherlands: 9.6%), environmental contamination (median adenosine triphosphate (ATP) level Belgium: 431 versus median ATP level The Netherlands: 793) and calculated hand hygiene actions based on alcohol based handrub consumption (Belgium: 12.5/day versus The Netherlands: 6.3/day) were found. Conclusion The Infection risk Scan was successfully implemented in multiple hospitals in a large cross-border project and provided data that made the quality of infection control and antimicrobial use more transparent. The observed differences provide potential targets for improvement of the quality of care.
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Affiliation(s)
- Martine Verelst
- Department of Infection Control, University Hospital Leuven, Leuven, Belgium.
| | - Ina Willemsen
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands
| | - Veronica Weterings
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands
| | | | | | - Ellen Nieuwkoop
- Department of Infection Control, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands
| | - Veroniek Saegeman
- Department of Infection Control, University Hospital Leuven, Leuven, Belgium
| | - Lieke van Alphen
- Departement of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+, Maastricht, The Netherlands
| | | | - Marjolein Kluytmans-van den Bergh
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands.,Julius Center for Health Sciences and Primary Care, UMC Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Jan Kluytmans
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands.,Julius Center for Health Sciences and Primary Care, UMC Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Annette Schuermans
- Department of Infection Control, University Hospital Leuven, Leuven, Belgium
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Bezabih YM, Bezabih A, Dion M, Batard E, Teka S, Obole A, Dessalegn N, Enyew A, Roujeinikova A, Alamneh E, Mirkazemi C, Peterson GM, Bezabhe WM. OUP accepted manuscript. JAC Antimicrob Resist 2022; 4:dlac048. [PMID: 35668909 PMCID: PMC9160884 DOI: 10.1093/jacamr/dlac048] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 04/07/2022] [Indexed: 11/12/2022] Open
Abstract
Objectives The widespread intestinal carriage of ESBL-producing Escherichia coli (ESBL E. coli) among both patients and healthy individuals is alarming. However, the global prevalence and trend of this MDR bacterium in healthcare settings remains undetermined. To address this knowledge gap, we performed a comparative meta-analysis of the prevalence in community and healthcare settings. Methods Our systematic review included 133 articles published between 1 January 2000 and 22 April 2021 and indexed in PubMed, EMBASE or Google Scholar. A random-effects meta-analysis was performed to obtain the global pooled prevalence (community and healthcare settings). Subgroup meta-analyses were performed by grouping studies using the WHO regions and 5 year intervals of the study period. Results We found that 21.1% (95% CI, 19.1%–23.2%) of inpatients in healthcare settings and 17.6% (95% CI, 15.3%–19.8%) of healthy individuals worldwide carried ESBL E. coli in their intestine. The global carriage rate in healthcare settings increased 3-fold from 7% (95% CI, 3.7%–10.3%) in 2001–05 to 25.7% (95% CI, 19.5%–32.0%) in 2016–20, whereas in community settings it increased 10-fold from 2.6% (95% CI, 1.2%–4.0%) to 26.4% (95% CI, 17.0%–35.9%) over the same period. Conclusions The global and regional human intestinal ESBL E. coli carriage is increasing in both community and healthcare settings. Carriage rates were generally higher in healthcare than in community settings. Key relevant health organizations should perform surveillance and implement preventive measures to address the spread of ESBL E. coli in both settings.
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Affiliation(s)
- Yihienew M. Bezabih
- Arsi University College of Health Sciences, University Road, Asella, ET 0193, Ethiopia
- Department of Internal Medicine, WellStar Atlanta Medical Center, Atlanta, GA, USA
- Corresponding author. E-mail: ; @myihienew
| | | | - Michel Dion
- University of Nantes, Microbiotas Hosts Antibiotics and bacterial Resistances Laboratory, Nantes, France
| | - Eric Batard
- University of Nantes, Microbiotas Hosts Antibiotics and bacterial Resistances Laboratory, Nantes, France
- CHU Nantes, Emergency Department, Nantes, France
| | - Samson Teka
- Marshall University School of Medicine, Huntington, WV, USA
| | - Abiy Obole
- Department of Internal Medicine, WellStar Atlanta Medical Center, Atlanta, GA, USA
| | - Noah Dessalegn
- Department of Internal Medicine, WellStar Atlanta Medical Center, Atlanta, GA, USA
| | | | - Anna Roujeinikova
- Department of Microbiology, Monash University, Clayton, Victoria 3800, Australia
| | - Endalkachew Alamneh
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
| | - Corinne Mirkazemi
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
| | - Gregory M. Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
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The Magnitude of Carbapenemase and ESBL Producing Enterobacteriaceae Isolates from Patients with Urinary Tract Infections at Tikur Anbessa Specialized Teaching Hospital, Addis Ababa, Ethiopia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1369:117-128. [PMID: 34914083 DOI: 10.1007/5584_2021_687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The emergence of multidrug-resistant organisms, such as extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE), and carbapenemase-producing Enterobacteriaceae (CPE) is a public health concern. Therefore, this study aimed to determine the magnitude of carbapenemase and ESBL producing bacteria isolated from patients affected by Urinary Tract Infection (UTI). METHODS A cross-sectional study was conducted from December 2018 to March 2019 at Tikur Anbessa Specialized Hospital. A total of 120 Enterobacteriaceae isolates from UTI patients were collected and identified on species level using standard microbiological methods. Antimicrobial susceptibility test was determined according to the guidelines of the Clinical and Laboratory Standards Institute. Detection of ESBL production was carried out by using ESBL ChromoSelect Agar medium and the combined disk diffusion. Production of carbapenemase was determined by using Hodge-test and modified carbapenem inactivation method as described in CLSI guidelines. RESULTS Out of the total 120 Enterobacteriaceae isolates, 74 (61.7%) were ESBL-producers, and 8 (6.7%) were carbapenemase producers. The most common ESBL producing isolate was E.coli 38 (51.4%) and the most common carbapenemase-producing isolate was K.pneumoniae five (62.5%). Most of the ESBL and carbapenemase-producing isolates were recovered from hospitalized patients 46 (62.2%) and 7 (87.5%) respectively. The rate of ESBL and CPE production was observed high among patients taking antibiotics 64.8% (59/91) and 7.7% (7/91) respectively, but no significant association was observed p > 0.05. Furthermore, about 1.7% (2/120) isolates were found both ESBL and carbapenemase producers. Significant resistances rates were observed in ESBL and CPE isolates. CONCLUSION Enterobacteriaceae isolates showed a significantly higher rate of ESBL production. A significant figure of carbapenemase production was observed among Enterobacteriaceae isolates causing UTI. The production of ESBL and CPE enhanced for an increased rate of MDR patterns. Efforts need to be made to introduce a system for tracking and detecting ESBL-PE and CPE-producing bacteria in hospitals, and monitoring dissemination of ESBL and CPE-producing Enterobacteriaceae is strongly recommended.
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Vock I, Aguilar-Bultet L, Egli A, Tamma PD, Tschudin-Sutter S. Risk factors for colonization with multiple species of extended-spectrum beta-lactamase producing Enterobacterales: a case-case-control study. Antimicrob Resist Infect Control 2021; 10:153. [PMID: 34689820 PMCID: PMC8543947 DOI: 10.1186/s13756-021-01018-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 11% of patients colonized with extended-spectrum beta-lactamase producing Enterobacterales (ESBL-PE) are colonized with more than one ESBL-producing species. We investigated risk factors associated with colonization with multiple ESBL-PE species. METHODS We performed a case-case-control study at the University Hospital Basel, Switzerland, including hospitalized patients colonized with ESBL-PE between 01/2008 and 12/2018. Patients colonized with multiple species of ESBL-PE during the same hospitalization were assigned to group 1. Group 2 consisted of patients with ESBL-PE and a newly acquired ESBL-PE-species identified during subsequent hospitalization. Controls (i.e., group 3) were patients with only one species of ESBL-PE identified over multiple hospitalizations. Controls were frequency-matched 3:1 to group 2 cases according to time-at-risk (i.e., days between ESBL-PE detection during first and subsequent hospitalizations) to standardize the duration of colonization. ESBL was identified with phenotypic assay and the presence of ESBL genes was confirmed by whole genome sequencing. RESULTS Among 1559 inpatients, 154 cases met eligibility criteria (67 in group 1, 22 in group 2, 65 in group 3). International travel within the previous 12 months (OR 12.57, 95% CI 3.48-45.45, p < 0.001) and antibiotic exposure within the previous 3 months (OR 2.96, 95% CI 1.37-6.41, p = 0.006) were independently associated with co-colonization with multiple ESBL-PE species. Admission from another acute-care facility was the only predictor of replacement of one ESBL-PE species with another during subsequent hospitalizations (OR 6.02, 95% CI 1.15-31.49, p = 0.003). CONCLUSION These findings point to strain-related factors being the main drivers of co-colonization with different ESBL-PE and may support stratification of infection prevention and control measures according to ESBL-PE species/strains.
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Affiliation(s)
- Isabelle Vock
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Lisandra Aguilar-Bultet
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Adrian Egli
- Division of Bacteriology and Mycology, University Hospital Basel, University of Basel, Basel, Switzerland.,Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Pranita D Tamma
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. .,Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
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30
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Willems RPJ, van Dijk K, Dierikx CM, Twisk JWR, van der Klis FRM, de Greeff SC, Vandenbroucke-Grauls CMJE. Gastric acid suppression, lifestyle factors and intestinal carriage of ESBL and carbapenemase-producing Enterobacterales: a nationwide population-based study. J Antimicrob Chemother 2021; 77:237-245. [PMID: 34550358 PMCID: PMC8730682 DOI: 10.1093/jac/dkab345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/15/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Gastric acid-suppressive therapy has been suggested to increase the risk for intestinal carriage of MDR Enterobacterales, but there is scarce community-based evidence substantiating this risk. OBJECTIVES To investigate if acid-suppressant use is associated with a risk of intestinal carriage of ESBL and carbapenemase-producing Enterobacterales (ESBL-E) in the open population, and to assess possible modifying factors. METHODS Within the framework of a nationwide seroprevalence study, we identified a population-based cross-sectional cohort comprising 2746 adults (≥18 years), who provided stool specimens between February 2016 and June 2017. Specimens were tested by phenotypic assays and confirmatory genotype analysis to detect carriage of ESBL-E. Covariate data were extracted from self-administered questionnaires. ORs and 95% CIs were estimated using multivariable multilevel logistic regression, controlling for confounders informed by directed acyclic graphs. RESULTS Among 2746 participants, 316 (11.5%) used acid suppressants; the prevalence of ESBL-E carriage was 7.4% (95% CI, 6.1%-8.6%). Current use of acid suppressants was not associated with ESBL-E carriage (adjusted OR [aOR], 1.05; 95% CI, 0.64-1.74); lifestyle and comorbidity did not modify this association. A higher BMI (≥25 kg/m2) (aOR, 1.42 [95% CI, 1.02-1.98]), non-Western ethnic origin (aOR, 1.96 [95% CI, 1.34-2.87]), travel to Eastern-Mediterranean, Western-Pacific or South-East Asia regions (aOR, 3.16 [95% CI, 1.71-5.83]) were associated with ESBL-E carriage. Sensitivity analyses confirmed these results; spline analysis supported a BMI-associated risk. CONCLUSIONS In this open population study, current use of acid suppressants was not associated with ESBL-E carriage. Travel to high-endemic regions and non-Western ethnicity were confirmed as risk factors, while a higher BMI emerged as a potential new risk for ESBL-E carriage.
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Affiliation(s)
- Roel P J Willems
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, Amsterdam UMC, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Karin van Dijk
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, Amsterdam UMC, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Cindy M Dierikx
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jos W R Twisk
- Department of Clinical Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Fiona R M van der Klis
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Centre for Immunology of Infectious Diseases and Vaccines-Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Sabine C de Greeff
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Centre for Epidemiology and Surveillance of Infectious Diseases-Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Christina M J E Vandenbroucke-Grauls
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, Amsterdam UMC, Amsterdam Medical Center, Amsterdam, The Netherlands
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31
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Hakuta R, Nakai Y, Hamada T, Nomura Y, Saito T, Takahara N, Mizuno S, Kogure H, Moriya K, Koike K. Use of proton pump inhibitors and cholangitis complicated with multi-drug resistant bacteria. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 29:230-238. [PMID: 34382333 DOI: 10.1002/jhbp.1035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/13/2021] [Accepted: 07/30/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Multidrug-resistant bacteria (MDRB) has rapidly spread worldwide and become a serious problem. Proton pump inhibitors (PPIs) are a class of commonly prescribed medications, but recent studies have suggested the increased risk of infection with MDRB in PPI users. We evaluated the association between PPI use and incidence of cholangitis with MDRB. METHODS Consecutive patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 2010 and August 2019 were included in this retrospective study. The incidence of cholangitis with MDRB was compared between regular and non-regular PPI users. RESULTS A total of 1224 regular PPI users and 1528 non-regular PPI users were identified. There was no clinically significant difference in age and sex between the groups. Indication of ERCP was different between the groups. The number of ERCP sessions during the study periods was higher in regular PPI users. The incidence of cholangitis with MDRB was significantly higher in regular PPI users (3.0% vs 1.1%; P < .001). Multivariable-adjusted odds ratio for cholangitis with MDRB comparing regular PPI users to non-regular users was 2.19 (95% confidence interval 1.20-4.00; P = .01). CONCLUSIONS Regular PPI use was associated with a higher risk of cholangitis with MDRB.
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Affiliation(s)
- Ryunosuke Hakuta
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Endoscopy and Endoscopic Surgery, The University of Tokyo, Tokyo, Japan
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Endoscopy and Endoscopic Surgery, The University of Tokyo, Tokyo, Japan
| | - Tsuyoshi Hamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yusuke Nomura
- Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomotaka Saito
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naminatsu Takahara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Suguru Mizuno
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirofumi Kogure
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kyoji Moriya
- Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Castanheira M, Simner PJ, Bradford PA. Extended-spectrum β-lactamases: an update on their characteristics, epidemiology and detection. JAC Antimicrob Resist 2021; 3:dlab092. [PMID: 34286272 PMCID: PMC8284625 DOI: 10.1093/jacamr/dlab092] [Citation(s) in RCA: 217] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Extended-spectrum β-lactamase (ESBL)-producing Gram-negative pathogens are a major cause of resistance to expanded-spectrum β-lactam antibiotics. Since their discovery in the early 1980s, they have spread worldwide and an are now endemic in Enterobacterales isolated from both hospital-associated and community-acquired infections. As a result, they are a global public health concern. In the past, TEM- and SHV-type ESBLs were the predominant families of ESBLs. Today CTX-M-type enzymes are the most commonly found ESBL type with the CTX-M-15 variant dominating worldwide, followed in prevalence by CTX-M-14, and CTX-M-27 is emerging in certain parts of the world. The genes encoding ESBLs are often found on plasmids and harboured within transposons or insertion sequences, which has enabled their spread. In addition, the population of ESBL-producing Escherichia coli is dominated globally by a highly virulent and successful clone belonging to ST131. Today, there are many diagnostic tools available to the clinical microbiology laboratory and include both phenotypic and genotypic tests to detect β-lactamases. Unfortunately, when ESBLs are not identified in a timely manner, appropriate antimicrobial therapy is frequently delayed, resulting in poor clinical outcomes. Several analyses of clinical trials have shown mixed results with regards to whether a carbapenem must be used to treat serious infections caused by ESBLs or whether some of the older β-lactam-β-lactamase combinations such as piperacillin/tazobactam are appropriate. Some of the newer combinations such as ceftazidime/avibactam have demonstrated efficacy in patients. ESBL-producing Gram-negative pathogens will continue to be major contributor to antimicrobial resistance worldwide. It is essential that we remain vigilant about identifying them both in patient isolates and through surveillance studies.
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van Kleef E, Wielders CCH, Schouls LM, Feenstra SG, Hertogh CMPM, Bonten MJM, van Weert Y, Tostmann A, van der Lubben M, de Greeff SC. National point prevalence study on carriage of multidrug-resistant microorganisms in Dutch long-term care facilities in 2018. J Antimicrob Chemother 2021; 76:1604-1613. [PMID: 33694365 DOI: 10.1093/jac/dkab042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/21/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Long-term care facilities (LTCFs) may act as a reservoir of ESBL-producing Enterobacterales (ESBL-E) and carbapenemase-producing Enterobacterales (CPE) for hospitals and the general population. In this study, we estimated the prevalence and molecular epidemiology of rectal carriage with ESBL-E and CPE in residents of Dutch LTCFs between March 2018 and December 2018. METHODS LTCFs were geographically selected across the country. For each LTCF, a random sample of residents were tested for ESBL-E and CPE in 2018. To identify risk factors for high carriage prevalence and/or individual carriage, characteristics of LTCFs and of a subset of the tested residents were collected. WGS was conducted on isolates from LTCFs with an ESBL-E prevalence of >10% and all CPE isolates to identify institutional clonal transmission. RESULTS A total of 4420 residents of 159 LTCFs were included. The weighted mean ESBL-E prevalence was 8.3% (95% CI: 6.8-10.0) and no CPE were found. In 53 LTCFs (33%), where ESBL-E prevalence was >10%, MLST using WGS (wgMLST) was performed. This included 264 isolates, the majority being Escherichia coli (n = 224) followed by Klebsiella pneumoniae (n = 30). Genetic clusters were identified in more than half (30/53; 57%) of high ESBL-positive LTCFs. Among the E. coli isolates, blaCTX-M-15 (92/224; 41%) and blaCTX-M-27 (40/224; 18%) were the most prevalent ESBL-encoding genes. For K. pneumoniae isolates, the most common was blaCTX-M-15 (23/30; 80%). CONCLUSIONS The estimated prevalence of ESBL-E rectal carriage in Dutch LTCFs is 8.3% and resistance is observed mainly in E. coli with predominance of blaCTX-M-15 and blaCTX-M-27. ESBL-E prevalence in LTCFs seems comparable to previously reported prevalence in hospitals and the general population.
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Affiliation(s)
- Esther van Kleef
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium.,Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM) Bilthoven, The Netherlands
| | - Cornelia C H Wielders
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM) Bilthoven, The Netherlands
| | - Leo M Schouls
- Centre for Infectious Disease Research, Diagnostics and Laboratory Surveillance, National Institute for Public Health and the Environment (RIVM) Bilthoven, The Netherlands
| | - Sabiena G Feenstra
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM) Bilthoven, The Netherlands
| | - Cees M P M Hertogh
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM) Bilthoven, The Netherlands.,Department of General Practice & Old Age Medicine, Amsterdam Public Health Research Institute, Amsterdam Medical Centers, Amsterdam, The Netherlands
| | - Marc J M Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Yolanda van Weert
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM) Bilthoven, The Netherlands
| | - Alma Tostmann
- Hygiene and Infection Prevention Unit, Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud university medical centre, Nijmegen, The Netherlands.,Regional Epidemiology Consultant, Gelderland AMR and Infection Prevention Network, The Netherlands
| | - Mariken van der Lubben
- Regional laboratory, Municipal Health Service (GGD) Amsterdam, Amsterdam, The Netherlands
| | - Sabine C de Greeff
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM) Bilthoven, The Netherlands
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34
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Rohde AM, Zweigner J, Wiese-Posselt M, Schwab F, Behnke M, Kola A, Schröder W, Peter S, Tacconelli E, Wille T, Feihl S, Querbach C, Gebhardt F, Gölz H, Schneider C, Mischnik A, Vehreschild MJGT, Seifert H, Kern WV, Gastmeier P, Hamprecht A. Prevalence of third-generation cephalosporin-resistant Enterobacterales colonization on hospital admission and ESBL genotype-specific risk factors: a cross-sectional study in six German university hospitals. J Antimicrob Chemother 2021; 75:1631-1638. [PMID: 32173738 DOI: 10.1093/jac/dkaa052] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/15/2020] [Accepted: 01/28/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To assess the admission prevalence of third-generation cephalosporin-resistant Enterobacterales (3GCREB) and to assess whether risk factors vary by β-lactamase genotype. METHODS Adult patients were recruited within 72 h of admission to general wards of six university hospitals in 2014 and 2015. Rectal swabs were screened for 3GCREB and isolates were analysed phenotypically and genotypically. Patients were questioned on potential risk factors. Multivariable analyses were performed to identify risk factors for 3GCREB colonization and for specific β-lactamases. RESULTS Of 8753 patients screened, 828 were 3GCREB positive (9.5%). Eight hundred and thirteen isolates were available for genotyping. CTX-M-15 was the most common ESBL (38.0%), followed by CTX-M-1 (22.5%), CTX-M-14 (8.7%), CTX-M-27 (7.5%) and SHV-ESBL (4.4%). AmpC was found in 11.9%. Interestingly, 18 Escherichia coli isolates were AmpC positive, 12 of which (67%) contained AmpC on a gene of plasmid origin [CMY (n = 10), DHA (n = 2)]. Risk factors for 3GCREB colonization varied by genotype. Recent antibiotic exposure and prior colonization by antibiotic-resistant bacteria were risk factors for all β-lactamases except CTX-M-14 and CTX-M-27. Travel outside Europe was a risk factor for CTX-M-15 and CTX-M-27 [adjusted OR (aOR) 3.49, 95% CI 2.88-4.24 and aOR 2.73, 95% CI 1.68-4.43]. A previous stay in a long-term care facility was associated with CTX-M-14 (aOR 3.01, 95% CI 1.98-4.59). A preceding hospital stay in Germany increased the risk of CTX-M-15 (aOR 1.27, 95% CI 1.14-1.41), while a prior hospital stay in other European countries increased the risk of SHV-ESBL colonization (aOR 3.85, 95% CI 1.67-8.92). CONCLUSIONS The detection of different ESBL types is associated with specific risk factor sets that might represent distinct sources of colonization and ESBL-specific dissemination routes.
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Affiliation(s)
- Anna M Rohde
- German Centre for Infection Research Association (DZIF), Braunschweig Germany.,Institute for Hygiene and Environmental Medicine, Charité - Universitätsmedizin Berlin, Germany, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
| | - Janine Zweigner
- German Centre for Infection Research Association (DZIF), Braunschweig Germany.,Institute for Hygiene and Environmental Medicine, Charité - Universitätsmedizin Berlin, Germany, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health.,Department of Hospital Hygiene and Infection Control, University Hospital Cologne, Cologne, Germany
| | - Miriam Wiese-Posselt
- German Centre for Infection Research Association (DZIF), Braunschweig Germany.,Institute for Hygiene and Environmental Medicine, Charité - Universitätsmedizin Berlin, Germany, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
| | - Frank Schwab
- German Centre for Infection Research Association (DZIF), Braunschweig Germany.,Institute for Hygiene and Environmental Medicine, Charité - Universitätsmedizin Berlin, Germany, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
| | - Michael Behnke
- German Centre for Infection Research Association (DZIF), Braunschweig Germany.,Institute for Hygiene and Environmental Medicine, Charité - Universitätsmedizin Berlin, Germany, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
| | - Axel Kola
- German Centre for Infection Research Association (DZIF), Braunschweig Germany.,Institute for Hygiene and Environmental Medicine, Charité - Universitätsmedizin Berlin, Germany, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
| | - Wiebke Schröder
- German Centre for Infection Research Association (DZIF), Braunschweig Germany.,Division of Infectious Diseases, Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany
| | - Silke Peter
- German Centre for Infection Research Association (DZIF), Braunschweig Germany.,Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
| | - Evelina Tacconelli
- German Centre for Infection Research Association (DZIF), Braunschweig Germany.,Division of Infectious Diseases, Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany
| | - Thorsten Wille
- German Centre for Infection Research Association (DZIF), Braunschweig Germany.,Institute for Medical Microbiology, Immunology and Hygiene, University Hospital Cologne, Cologne, Germany
| | - Susanne Feihl
- German Centre for Infection Research Association (DZIF), Braunschweig Germany.,Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany
| | - Christiane Querbach
- German Centre for Infection Research Association (DZIF), Braunschweig Germany.,Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany
| | - Friedemann Gebhardt
- German Centre for Infection Research Association (DZIF), Braunschweig Germany.,Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany
| | - Hannah Gölz
- German Centre for Infection Research Association (DZIF), Braunschweig Germany.,Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, Freiburg, Germany
| | - Christian Schneider
- German Centre for Infection Research Association (DZIF), Braunschweig Germany.,Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, Freiburg, Germany
| | - Alexander Mischnik
- German Centre for Infection Research Association (DZIF), Braunschweig Germany.,Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, Freiburg, Germany
| | - Maria J G T Vehreschild
- German Centre for Infection Research Association (DZIF), Braunschweig Germany.,Department I of Internal Medicine, University Hospital of Cologne, Germany.,Department of Internal Medicine, Infectious Diseases, Goethe University, Frankfurt am Main, Germany
| | - Harald Seifert
- German Centre for Infection Research Association (DZIF), Braunschweig Germany.,Institute for Medical Microbiology, Immunology and Hygiene, University Hospital Cologne, Cologne, Germany
| | - Winfried V Kern
- German Centre for Infection Research Association (DZIF), Braunschweig Germany.,Division of Infectious Diseases, Department of Medicine II, Medical Centre and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Petra Gastmeier
- German Centre for Infection Research Association (DZIF), Braunschweig Germany.,Institute for Hygiene and Environmental Medicine, Charité - Universitätsmedizin Berlin, Germany, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
| | - Axel Hamprecht
- German Centre for Infection Research Association (DZIF), Braunschweig Germany.,Institute for Medical Microbiology, Immunology and Hygiene, University Hospital Cologne, Cologne, Germany
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35
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Meijs AP, Gijsbers EF, Hengeveld PD, Veenman C, van Roon AM, van Hoek AHAM, de Greeff SC, van Duijkeren E, Dierikx CM. Do vegetarians less frequently carry ESBL/pAmpC-producing Escherichia coli/Klebsiella pneumoniae compared with non-vegetarians? J Antimicrob Chemother 2021; 75:550-558. [PMID: 31764980 DOI: 10.1093/jac/dkz483] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/15/2019] [Accepted: 10/22/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND ESBL and plasmid-mediated AmpC (pAmpC)-producing Enterobacteriaceae are frequently found on meat products in Dutch retail, especially on poultry. OBJECTIVES We investigated whether vegetarians are at lower risk of carrying ESBL/pAmpC-producing Escherichia coli/Klebsiella pneumoniae (ESBL-E/K) compared with persons who consume meat. METHODS Vegetarians, pescatarians (vegetarians who eat fish) and non-vegetarians (persons who eat meat at least three times per week) were asked to send in a faecal sample and a questionnaire. ESBL-E/K were cultured and MLSTs were determined. ESBL/pAmpC genes were analysed using PCR and sequencing. The risk of ESBL-E/K carriage in the three study groups was analysed using multivariable logistic regression. RESULTS Prevalence of ESBL-E/K carriage was 8.0% in vegetarians (63/785; 95% CI 6.3-10.1), 6.9% in pescatarians (27/392; 95% CI 4.8-9.8) and 3.8% in non-vegetarians (14/365; 95% CI 2.3-6.3). Multivariable analysis showed an OR for ESBL-E/K carriage of 2.2 for vegetarians (95% CI 1.2-4.0) and 1.6 for pescatarians (95% CI 0.8-3.2) compared with non-vegetarians. The predominant MLST was E. coli ST131 and the most common ESBL genes were blaCTX-M-15, blaCTX-M-27, blaCTX-M-14 and blaCTX-M-1 in all diet groups. Independent risk factors for ESBL-E/K carriage were travel to Africa/Latin America/Asia (OR 4.6; 95% CI 2.8-7.7) in the past 6 months and rarely/never washing hands before food preparation (OR 2.5; 95% CI 1.2-5.0). CONCLUSIONS Vegetarians and pescatarians did not have a lower risk of ESBL-E/K carriage compared with non-vegetarians, indicating that eating meat is not an important risk factor for ESBL-E/K carriage.
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Affiliation(s)
- Anouk P Meijs
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Esther F Gijsbers
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Paul D Hengeveld
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Christiaan Veenman
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Annika M van Roon
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Angela H A M van Hoek
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Sabine C de Greeff
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Engeline van Duijkeren
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Cindy M Dierikx
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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36
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Maataoui N, Langendorf C, Berthe F, Bayjanov JR, van Schaik W, Isanaka S, Grais RF, Clermont O, Andremont A, Armand-Lefèvre L, Woerther PL. Increased risk of acquisition and transmission of ESBL-producing Enterobacteriaceae in malnourished children exposed to amoxicillin. J Antimicrob Chemother 2021; 75:709-717. [PMID: 31821452 DOI: 10.1093/jac/dkz487] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/05/2019] [Accepted: 10/23/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Routine amoxicillin for children with uncomplicated severe acute malnutrition raises concerns of increasing antibiotic resistance. We performed an ancillary study nested within a double-blind, placebo-controlled trial in Niger testing the role of routine 7 day amoxicillin therapy in nutritional recovery of children 6 to 59 months of age with uncomplicated severe acute malnutrition. METHODS We screened 472 children for rectal carriage of ESBL-producing Enterobacteriaceae (ESBL-E) as well as their household siblings under 5 years old, at baseline and Week 1 (W1) and Week 4 (W4) after start of therapy, and characterized strains by WGS. ClinicalTrials.gov: NCT01613547. RESULTS Carriage in index children at baseline was similar in the amoxicillin and the placebo groups (33.8% versus 27.9%, P = 0.17). However, acquisition of ESBL-E in index children at W1 was higher in the amoxicillin group than in the placebo group (53.7% versus 32.2%, adjusted risk ratio = 2.29, P = 0.001). Among 209 index and sibling households possibly exposed to ESBL-E transmission, 16 (7.7%) had paired strains differing by ≤10 SNPs, suggesting a high probability of transmission. This was more frequent in households from the amoxicillin group than from the placebo group [11.5% (12/104) versus 3.8% (4/105), P = 0.04]. CONCLUSIONS Among children exposed to amoxicillin, ESBL-E colonization was more frequent and the risk of transmission to siblings higher. Routine amoxicillin should be carefully balanced with the risks associated with ESBL-E colonization.
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Affiliation(s)
- Naouale Maataoui
- Laboratoire de Bactériologie, Hôpital Bichat-Claude-Bernard, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France.,Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Paris, France.,Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
| | | | - Fatou Berthe
- Department of Research, Epicentre, Paris, France and Maradi, Niger
| | - Jumamurat R Bayjanov
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Willem van Schaik
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - Sheila Isanaka
- Department of Research, Epicentre, Paris, France and Maradi, Niger
| | - Rebecca F Grais
- Department of Research, Epicentre, Paris, France and Maradi, Niger
| | - Olivier Clermont
- Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Paris, France
| | - Antoine Andremont
- Laboratoire de Bactériologie, Hôpital Bichat-Claude-Bernard, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France.,Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Paris, France.,Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
| | - Laurence Armand-Lefèvre
- Laboratoire de Bactériologie, Hôpital Bichat-Claude-Bernard, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France.,Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Paris, France.,Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
| | - Paul-Louis Woerther
- Department of Microbiology and Infection Control, Henri-Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France.,EA 7380 Dynamyc, EnvA, UPEC, Paris-Est University, Créteil, France
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37
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Honsbeek M, Tjon-A-Tsien A, Omeragic E, Stobberingh E, van Oorschot W, Vos M, Richardus JH, Voeten H. Obtaining nasal and rectal swabs from general practice patients to assess carriage of antibiotic resistant microorganisms: a feasibility study. Fam Pract 2021; 38:280-285. [PMID: 33095857 DOI: 10.1093/fampra/cmaa111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The aim of this study was to assess the feasibility of obtaining nasal and rectal swabs from general practice patients for measuring carriage of antibiotic resistant microorganisms in an area in Rotterdam (the Netherlands) with low socioeconomic status and a large immigrant population. METHODS Data collection was from May to December 2017, in one general practice in Rotterdam. We asked adults (≥18 years) visiting the general practitioner (GP) with complaints not related to infections for one nasal and two rectal swabs and tested these for highly resistant microorganisms (HRMOs). Indicators for feasibility were recruitment rate, implementation and acceptation of data collection procedures by the participants. RESULTS We obtained a nasal swab from all included 234 patients and 164 (70%) also gave rectal swabs. On average, 3 out of 30 invited patients (10%) were recruited per day. The GPs considered the workload high to inform and refer to eligible patients for the study and did this inconsistently. Most participants experienced the rectal swab procedure as burdensome and preferred assistance of a medical assistant above self-swabbing. A monetary incentive increased the willingness to provide rectal swabs. CONCLUSIONS Obtaining (nasal and) rectal swabs from general practice patients for study purposes proved difficult. Lessons learnt from this feasibility study will help increase participation in HRMO prevalence studies among asymptomatic general practice patients.
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Affiliation(s)
- Maaike Honsbeek
- Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.,Department of Health Care, University of Applied Sciences Leiden, Leiden, The Netherlands
| | - Aimée Tjon-A-Tsien
- Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
| | - Emina Omeragic
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ellen Stobberingh
- Department of Medical Microbiology, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | | | - Margreet Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan Hendrik Richardus
- Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hélène Voeten
- Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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38
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van den Bunt G, Fluit AC, Spaninks MP, Timmerman AJ, Geurts Y, Kant A, Scharringa J, Mevius D, Wagenaar JA, Bonten MJM, van Pelt W, Hordijk J. Faecal carriage, risk factors, acquisition and persistence of ESBL-producing Enterobacteriaceae in dogs and cats and co-carriage with humans belonging to the same household. J Antimicrob Chemother 2021; 75:342-350. [PMID: 31711228 PMCID: PMC6966097 DOI: 10.1093/jac/dkz462] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/06/2019] [Accepted: 10/10/2019] [Indexed: 11/21/2022] Open
Abstract
Background ESBL-producing Enterobacteriaceae (ESBL-E) are observed in many reservoirs. Pets might play an important role in the dissemination of ESBL-E to humans since they live closely together. Objectives To identify prevalence, risk factors, molecular characteristics, persistence and acquisition of ESBL-E in dogs and cats, and co-carriage in human–pet pairs belonging to the same household. Methods In a nationwide study, one person per household was randomly invited to complete a questionnaire and to submit a faecal sample. Dog and cat owners were invited to also submit a faecal sample from their pet. Repeated sampling after 1 and 6 months was performed in a subset. ESBL-E were obtained through selective culture and characterized by WGS. Logistic regression analyses and random forest models were performed to identify risk factors. Results The prevalence of ESBL-E carriage in these cohorts was 3.8% (95% CI: 2.7%–5.4%) for human participants (n=550), 10.7% (95% CI: 8.3%–13.7%) for dogs (n=555) and 1.4% (95% CI: 0.5%–3.8%) for cats (n=285). Among animals, blaCTX-M-1 was most abundant, followed by blaCTX-M-15. In dogs, persistence of carriage was 57.1% at 1 month and 42.9% at 6 months. Eating raw meat [OR: 8.8, 95% CI: 4.7–16.4; population attributable risk (PAR): 46.5%, 95% CI: 41.3%–49.3%] and dry food (OR: 0.2, 95% CI: 0.1–0.5; PAR: 56.5%, 95% CI: 33.2%–66.6%) were predictors for ESBL-E carriage in dogs. Human–dog co-carriage was demonstrated in five households. Human–cat co-carriage was not observed. Conclusions ESBL-E prevalence was higher in dogs than in humans and lowest in cats. The main risk factor for ESBL-E carriage was eating raw meat. Co-carriage in dogs and household members was uncommon.
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Affiliation(s)
- G van den Bunt
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - A C Fluit
- Department of Medical Microbiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - M P Spaninks
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - A J Timmerman
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Y Geurts
- Department of Bacteriology and Epidemiology, Wageningen Bioveterinary Research, Lelystad, The Netherlands
| | - A Kant
- Department of Bacteriology and Epidemiology, Wageningen Bioveterinary Research, Lelystad, The Netherlands
| | - J Scharringa
- Department of Medical Microbiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - D Mevius
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.,Department of Bacteriology and Epidemiology, Wageningen Bioveterinary Research, Lelystad, The Netherlands
| | - J A Wagenaar
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.,Department of Bacteriology and Epidemiology, Wageningen Bioveterinary Research, Lelystad, The Netherlands
| | - M J M Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - W van Pelt
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - J Hordijk
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Frequency of and risk factors for beta-lactamase-producing Escherichia coli Isolates in hospitalized patients. DRUGS & THERAPY PERSPECTIVES 2021. [DOI: 10.1007/s40267-021-00829-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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40
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Tufic-Garutti SDS, Ramalho JVAR, Longo LGDA, de Oliveira GC, Rocha GT, Vilar LC, Dias da Costa M, Picão RC, Girão VBDC, Santoro-Lopes G, Moreira BM, Rodrigues KMDP. Acquisition of antimicrobial resistance determinants in Enterobacterales by international travelers from a large urban setting in Brazil. Travel Med Infect Dis 2021; 41:102028. [PMID: 33737162 DOI: 10.1016/j.tmaid.2021.102028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/18/2020] [Accepted: 03/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Antimicrobial resistance is increased by international mobility. We present data about intestinal colonization of travelers departing from a middle-income country. METHODS Travelers were recruited from 2015 to 2019, collected an anal stool specimen and answered a questionnaire before and after travel. Enterobacterales isolates were investigated for antimicrobial resistance; extended-spectrum beta-lactamase (ESBL) and carbapenemase production; plasmid-encoded cephalosporinases (pAmpC), plasmid-mediated quinolone resistance (PMQR) and mcr genes by PCR and sequencing; and association with travel related variables. RESULTS Among 210 travelers, 26 (12%) carried multidrug-resistant Enterobacterales (MDR-E) and 18 (9%) ESBL-producing Enterobacterales (ESBL-E) before travel, with an increased prevalence from 1% to 11% over the study years. Acquisition of MDR-E and ESBL-E occurred in 59 (32%) and 43 (22%) travelers, respectively, mostly blaCTX-M-15 carrying Escherichia coli. One traveler acquired one isolate carrying blaOXA-181 gene, and two others, isolates carrying mcr-1. PMQR were detected in 14 isolates of returning travelers. The risk of MDR-E acquisition was higher in Southeast Asia and the Indian subcontinent, and after using antimicrobial agents. CONCLUSION We describe an increasing pre-travel prevalence of ESBL-E colonization in subjects departing from this middle-income country over time. Travel to known risk areas and use of antimicrobial agents during travel were associated with acquisition of MDR-E. Travel advice is critical to mitigating this risk, as colonization by MDR-E may raise the chances of antimicrobial-resistant infections.
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Affiliation(s)
| | - João Vitor Almeida Ramalho Ramalho
- Departamento de Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Gabriel Taddeucci Rocha
- Instituto de Microbiologia Professor Paulo de Góes, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucas Cecílio Vilar
- Instituto de Microbiologia Professor Paulo de Góes, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcellus Dias da Costa
- Laboratório de Imunização e Vigilância Em Saúde (LIVS) - Instituto Nacional de Infectologia - Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Renata Cristina Picão
- Instituto de Microbiologia Professor Paulo de Góes, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Guilherme Santoro-Lopes
- Departamento de Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Beatriz Meurer Moreira
- Instituto de Microbiologia Professor Paulo de Góes, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Káris Maria de Pinho Rodrigues
- Centro de Informação Em Saúde para Viajantes, Faculdade de Medicina, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil.
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41
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Rivera-Izquierdo M, Láinez-Ramos-Bossini AJ, Rivera-Izquierdo C, López-Gómez J, Fernández-Martínez NF, Redruello-Guerrero P, Martín-delosReyes LM, Martínez-Ruiz V, Moreno-Roldán E, Jiménez-Mejías E. OXA-48 Carbapenemase-Producing Enterobacterales in Spanish Hospitals: An Updated Comprehensive Review on a Rising Antimicrobial Resistance. Antibiotics (Basel) 2021; 10:antibiotics10010089. [PMID: 33477731 PMCID: PMC7832331 DOI: 10.3390/antibiotics10010089] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/07/2021] [Accepted: 01/16/2021] [Indexed: 12/14/2022] Open
Abstract
Carbapenemase-producing Enterobacterales (CPE) are significant contributors to the global public health threat of antimicrobial resistance. OXA-48-like enzymes and their variants are unique carbapenemases with low or null hydrolytic activity toward carbapenems but no intrinsic activity against expanded-spectrum cephalosporins. CPEs have been classified by the WHO as high-priority pathogens given their association with morbidity and mortality and the scarce number of effective antibiotic treatments. In Spain, the frequency of OXA-48 CPE outbreaks is higher than in other European countries, representing the major resistance mechanism of CPEs. Horizontal transfer of plasmids and poor effective antibiotic treatment are additional threats to the correct prevention and control of these hospital outbreaks. One of the most important risk factors is antibiotic pressure, specifically carbapenem overuse. We explored the use of these antibiotics in Spain and analyzed the frequency, characteristics and prevention of CPE outbreaks. Future antibiotic stewardship programs along with specific preventive measures in hospitalized patients must be reinforced and updated in Spain.
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Affiliation(s)
- Mario Rivera-Izquierdo
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (C.R.-I.); (L.M.M.-d.); (V.M.-R.); (E.M.-R.); (E.J.-M.)
- Service of Preventive Medicine and Public Health, Hospital Clínico San Cecilio, 18016 Granada, Spain
- Biosanitary Institute of Granada, ibs.GRANADA, 18012 Granada, Spain
- Correspondence:
| | | | - Carlos Rivera-Izquierdo
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (C.R.-I.); (L.M.M.-d.); (V.M.-R.); (E.M.-R.); (E.J.-M.)
- Service of Ginecology and Obstetrics, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
| | - Jairo López-Gómez
- Service of Internal Medicine, San Cecilio University Hospital, 18016 Granada, Spain;
| | - Nicolás Francisco Fernández-Martínez
- Department of Preventive Medicine and Public Health, Reina Sofía University Hospital, 14004 Córdoba, Spain;
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), 14001 Córdoba, Spain
| | | | - Luis Miguel Martín-delosReyes
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (C.R.-I.); (L.M.M.-d.); (V.M.-R.); (E.M.-R.); (E.J.-M.)
| | - Virginia Martínez-Ruiz
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (C.R.-I.); (L.M.M.-d.); (V.M.-R.); (E.M.-R.); (E.J.-M.)
- Biosanitary Institute of Granada, ibs.GRANADA, 18012 Granada, Spain
- CIBER of Epidemiology and Public Health of Spain (CIBERESP), 28029 Madrid, Spain
| | - Elena Moreno-Roldán
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (C.R.-I.); (L.M.M.-d.); (V.M.-R.); (E.M.-R.); (E.J.-M.)
- Biosanitary Institute of Granada, ibs.GRANADA, 18012 Granada, Spain
| | - Eladio Jiménez-Mejías
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (C.R.-I.); (L.M.M.-d.); (V.M.-R.); (E.M.-R.); (E.J.-M.)
- Biosanitary Institute of Granada, ibs.GRANADA, 18012 Granada, Spain
- CIBER of Epidemiology and Public Health of Spain (CIBERESP), 28029 Madrid, Spain
- Teaching and Research in Family Medicine SEMERGEN-UGR, University of Granada, 18016 Granada, Spain
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Bokhary H, Pangesti KNA, Rashid H, Abd El Ghany M, Hill-Cawthorne GA. Travel-Related Antimicrobial Resistance: A Systematic Review. Trop Med Infect Dis 2021; 6:11. [PMID: 33467065 PMCID: PMC7838817 DOI: 10.3390/tropicalmed6010011] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 12/26/2022] Open
Abstract
There is increasing evidence that human movement facilitates the global spread of resistant bacteria and antimicrobial resistance (AMR) genes. We systematically reviewed the literature on the impact of travel on the dissemination of AMR. We searched the databases Medline, EMBASE and SCOPUS from database inception until the end of June 2019. Of the 3052 titles identified, 2253 articles passed the initial screening, of which 238 met the inclusion criteria. The studies covered 30,060 drug-resistant isolates from 26 identified bacterial species. Most were enteric, accounting for 65% of the identified species and 92% of all documented isolates. High-income countries were more likely to be recipient nations for AMR originating from middle- and low-income countries. The most common origin of travellers with resistant bacteria was Asia, covering 36% of the total isolates. Beta-lactams and quinolones were the most documented drug-resistant organisms, accounting for 35% and 31% of the overall drug resistance, respectively. Medical tourism was twice as likely to be associated with multidrug-resistant organisms than general travel. International travel is a vehicle for the transmission of antimicrobial resistance globally. Health systems should identify recent travellers to ensure that adequate precautions are taken.
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Affiliation(s)
- Hamid Bokhary
- School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia; (K.N.A.P.); (G.A.H.-C.)
- University Medical Center, Umm Al-Qura University, Al Jamiah, Makkah, Makkah Region 24243, Saudi Arabia
- The Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Westmead, NSW 2145, Australia; (H.R.); or (M.A.E.G.)
- The Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
| | - Krisna N. A. Pangesti
- School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia; (K.N.A.P.); (G.A.H.-C.)
- The Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
| | - Harunor Rashid
- The Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Westmead, NSW 2145, Australia; (H.R.); or (M.A.E.G.)
- National Centre for Immunisation Research and Surveillance (NCIRS), Kids Research, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Moataz Abd El Ghany
- The Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Westmead, NSW 2145, Australia; (H.R.); or (M.A.E.G.)
- The Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
- The Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Grant A. Hill-Cawthorne
- School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia; (K.N.A.P.); (G.A.H.-C.)
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van Bilsen WPH, van Dulm E, Matser A, Linde I, van Duijnhoven YTHP, Prins JM, Prins M, Boyd A, van Dam AP. High carriage of ESBL-producing Enterobacteriaceae associated with sexual activity among men who have sex with men. Int J Antimicrob Agents 2021; 57:106276. [PMID: 33434675 DOI: 10.1016/j.ijantimicag.2021.106276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 12/10/2020] [Accepted: 01/03/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Extended-spectrum β-lactamase Enterobacteriaceae (ESBL-E) may be sexually transmitted. Men who have sex with men (MSM) have different sexual behaviour than the general population, and thus may be at risk for ESBL-E carriage. This study determined the prevalence of ESBL-E carriage and its association with sexual behaviour among MSM in Amsterdam, The Netherlands. MATERIALS AND METHODS In total, 583 HIV-positive and HIV-negative MSM from the Amsterdam Cohort Study were screened for rectal ESBL-E carriage between April and December 2018. Participants completed a self-administered questionnaire on (sexual) behaviour and risk factors for antimicrobial resistance. The proportion of the study population with ESBL-E carriage was compared by number of sexual partners using logistic regression, and across clusters of sexual behaviours with steady and casual partners, separately, using latent class analyses; all results were adjusted for recent use of antibiotics, travel and hospitalization. RESULTS Overall, 16.3% [95% confidence interval (CI) 13.4-19.5] of the study population tested positive for ESBL-E. The odds of ESBL-E carriage increased as number of sexual partners increased [adjusted odds ratio per ln(partner+1), 1.57, 95% CI 1.26-1.94; P<0.001]. There was no association between ESBL-E carriage and sexual behaviour with steady partner(s). Compared with participants in the 'no sex with casual partner(s)' cluster, adjusted odds of being ESBL-E positive were 2.95-fold higher (95% CI 1.52-5.80) for participants in the 'rimming and frottage' cluster (P=0.001) and 2.28-fold higher (95% CI 0.98-5.31) for participants in the 'toy use and fisting' cluster (P=0.056). CONCLUSIONS The prevalence of ESBL-E in MSM is higher compared with the overall Dutch population, likely due to sexual transmission with casual partners. This implies that sexually active MSM should be considered a risk group for ESBL-E carriage.
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Affiliation(s)
- Ward P H van Bilsen
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Eline van Dulm
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.
| | - Amy Matser
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Ineke Linde
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | | | - Jan M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands; Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anders Boyd
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands; HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - Alje P van Dam
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
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Agrawal S, Singh AP, Singh R, Saikia R, Choudhury S, Shukla A, Prabhu SN, Agrawal J. Molecular characterization of extended-spectrum β-lactamase-producing Escherichia coli isolated from postpartum uterine infection in dairy cattle in India. Vet World 2021; 14:200-209. [PMID: 33642805 PMCID: PMC7896901 DOI: 10.14202/vetworld.2021.200-209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 12/12/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND AIM Selection and dissemination of plasmid-encoded extended-spectrum β-lactamase (ESBL) among Enterobacteriaceae confers resistance to beta-lactam antibiotics. The purpose of this study was to determine the prevalence and molecular characteristics of ESBL-producing organisms isolated from dairy cattle with a uterine infection. MATERIALS AND METHODS Bacterial isolates (n=62) were characterized by biochemical test for genus and species determination. Antimicrobial susceptibility tests were performed by Kirby-Bauer disk diffusion method using panel of antibiotics for initial screening of ESBL organism. Phenotypic confirmation of ESBL-suspected strains was done by combination disk method and double-disk method. Multiplex polymerase chain reaction (PCR) was carried out for phylogrouping of Escherichia coli isolates as well as for genotyping ESBL genes. Enterobacterial repetitive intergenic consensus-PCR method was used for genotypic characterization of isolates. RESULTS Antibiotic susceptibility profile of E. coli (n=40) isolates showed high rates of resistance for ampicillin (95.0%), cefpodoxime (97.5%), cefotaxime (87.5%), and ceftriaxone (70%). However, low rates of resistance were observed for cefoxitin (25%), amoxicillin/clavulanic acid (20%), ceftazidime (17.5%), gentamicin (10%), and ertapenem (7.5%). A total of 39/40 E. coli isolates were confirmed as ESBL with Epsilometer test as well as the genotypic method and 28 (70%) of them were multidrug-resistant. Genotype blaCTX-M was observed as a predominant beta-lactamase type with the preponderance of CTX-M Group 1. The following combinations were observed: blaTEM + blaCTX-M in 15 (36.2%) isolates, blaTEM /blaSHV in 8 (5.2%) isolates, and blaCTX-M /blaSHV in 6 (5.2%) isolates. The phylogenetic grouping of E. coli strains revealed the highest prevalence for B1 (22.0%) followed by A (20%). CONCLUSION This report shows a high frequency of ESBL E. coli from cattle with postpartum uterine infections. These isolates showed reduced susceptibility to common antibiotics used for the treatment of uterine infections greater affecting the therapeutic outcome.
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Affiliation(s)
- Samiksha Agrawal
- College of Biotechnology, Uttar Pradesh Pandit Deen Dayal Upadhyaya Pashu Chikitsa Vigyan Vishwavidhyalaya Ewam Gau Anusandhan Sansthan Mathura, Uttar Pradesh, India
| | - Ajay Pratap Singh
- Department of Veterinary Microbiology, Uttar Pradesh Pandit Deen Dayal Upadhyaya Pashu Chikitsa Vigyan Vishwavidhyalaya Ewam Gau Anusandhan Sansthan Mathura, Uttar Pradesh, India
| | - Rashmi Singh
- Department of Veterinary Microbiology, Uttar Pradesh Pandit Deen Dayal Upadhyaya Pashu Chikitsa Vigyan Vishwavidhyalaya Ewam Gau Anusandhan Sansthan Mathura, Uttar Pradesh, India
| | - Raktim Saikia
- Department of Veterinary Pharmacology, Uttar Pradesh Pandit Deen Dayal Upadhyaya Pashu Chikitsa Vigyan Vishwavidhyalaya Ewam Gau Anusandhan Sansthan Mathura, Uttar Pradesh, India
| | - Soumen Choudhury
- Department of Veterinary Pharmacology, Uttar Pradesh Pandit Deen Dayal Upadhyaya Pashu Chikitsa Vigyan Vishwavidhyalaya Ewam Gau Anusandhan Sansthan Mathura, Uttar Pradesh, India
| | - Amit Shukla
- Department of Veterinary Pharmacology, Uttar Pradesh Pandit Deen Dayal Upadhyaya Pashu Chikitsa Vigyan Vishwavidhyalaya Ewam Gau Anusandhan Sansthan Mathura, Uttar Pradesh, India
| | - Shyama N. Prabhu
- Department of Veterinary Pathology, Uttar Pradesh Pandit Deen Dayal Upadhyaya Pashu Chikitsa Vigyan Vishwavidhyalaya Ewam Gau Anusandhan Sansthan Mathura, Uttar Pradesh, India
| | - Jitendra Agrawal
- Department of Animal Reproduction and Gynecology, College of Veterinary Science and Animal Husbandry, Uttar Pradesh Pandit Deen Dayal Upadhyaya Pashu Chikitsa Vigyan Vishwavidhyalaya Ewam Gau Anusandhan Sansthan Mathura, Uttar Pradesh, India
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Vendrik KEW, Terveer EM, Kuijper EJ, Nooij S, Boeije-Koppenol E, Sanders IMJG, van Lingen E, Verspaget HW, Berssenbrugge EKL, Keller JJ, van Prehn J. Periodic screening of donor faeces with a quarantine period to prevent transmission of multidrug-resistant organisms during faecal microbiota transplantation: a retrospective cohort study. THE LANCET. INFECTIOUS DISEASES 2020; 21:711-721. [PMID: 33275940 DOI: 10.1016/s1473-3099(20)30473-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/24/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND On June 13, 2019, the US Food and Drug Administration issued a warning after transfer of faeces containing an extended-spectrum β-lactamase (ESBL)-producing Escherichia coli by faecal microbiota transplantation led to bacteraemia in two immunocompromised patients. Consequently, we evaluated the effectiveness of the faeces donor-screening protocol of the Netherlands Donor Faeces Bank, which consists of screening of donors for multidrug-resistant organisms every 3 months, combined with additional screening on indication (eg, after travelling abroad) and application of a quarantine period for all faecal suspensions delivered within those 3 months. METHODS We did a retrospective cohort study of data collected between Jan 1, 2015, and Oct 14, 2019, on the multidrug-resistant organism testing results of donor faeces. Additionally, we tested previously quarantined faecal suspensions approved for faecal microbiota transplantation between Dec 12, 2016, and May 1, 2019, for the presence of multidrug-resistant organisms using both aselective and selective broth enrichment media. Whole-genome sequencing with core-genome multilocus sequence typing (cgMLST) was done on all multidrug-resistant isolates. FINDINGS Among initial screenings, six (9%) of 66 tested individuals were positive for multidrug-resistant organisms and 11 (17%) of 66 tested individuals were positive for multidrug-resistant organisms at any timepoint. Multidrug-resistant organisms were detected in four (25%) of 16 active donors, who had a median donation duration of 268 days (IQR 92 to 366). Among all screening results, 14 (74%) of 19 detected multidrug-resistant organisms were ESBL-producing E coli. 170 (49%) of 344 approved faecal suspensions had corresponding research faeces aliquots available and were tested (from 11 active donors with a median of eight [IQR five to 26] suspensions per donor). No multidrug-resistant organisms were detected in the 170 approved faecal suspensions (one-sided 95% CI 0 to 1·7). cgMLST revealed that all multidrug-resistant organisms were genetically different. INTERPRETATION Healthy faeces donors can become colonised with multidrug-resistant organisms during donation activities. Our screening protocol did not result in approval of multidrug-resistant organism-positive faecal suspensions for microbiota transplantation. FUNDING None.
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Affiliation(s)
- Karuna E W Vendrik
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - Elisabeth M Terveer
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - Ed J Kuijper
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands.
| | - Sam Nooij
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - Eline Boeije-Koppenol
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - Ingrid M J G Sanders
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - Emilie van Lingen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | - Hein W Verspaget
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands; Department of Biobanking, Leiden University Medical Center, Leiden, Netherlands
| | - Eric K L Berssenbrugge
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - Josbert J Keller
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands; Department of Gastroenterology, Haaglanden Medical Center, The Hague, Netherlands
| | - Joffrey van Prehn
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
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van den Bunt G, van Pelt W, Hidalgo L, Scharringa J, de Greeff SC, Schürch AC, Mughini-Gras L, Bonten MJM, Fluit AC. Prevalence, risk factors and genetic characterisation of extended-spectrum beta-lactamase and carbapenemase-producing Enterobacteriaceae (ESBL-E and CPE): a community-based cross-sectional study, the Netherlands, 2014 to 2016. ACTA ACUST UNITED AC 2020; 24. [PMID: 31615600 PMCID: PMC6794991 DOI: 10.2807/1560-7917.es.2019.24.41.1800594] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background The epidemiology of carriage of extended-spectrum beta-lactamase-producing (ESBL-E) and carbapenemase-producing Enterobacteriaceae (CPE) in the general population is unknown. Aim In this observational study, the prevalence and risk factors for intestinal ESBL-E and CPE carriage in the Dutch general population were determined. ESBL-E were characterised. Methods From 2014 to 2016, ca 2,000 residents were invited monthly to complete a questionnaire and provide a faecal sample, which was tested for ESBL-E. The first 1,758 samples were also tested for CPE. Risk factors for ESBL-E carriage were identified by multivariable logistic regression analysis. ESBL-E isolates underwent whole genome sequencing. Results Of 47,957 individuals invited, 4,177 (8.7%) completed the questionnaire and provided a faecal sample. ESBL-E were detected in 186 (4.5%) individuals, resulting in an adjusted prevalence of 5.0% (95% confidence interval (CI):3.4–6.6%). Risk factors were: born outside the Netherlands (odds ratio (OR): 1.99; 95% CI: 1.16−4.54), eating in restaurants > 20 times/year (OR: 1.70; 95% CI: 1.04−2.76), antibiotic use < 6 months ago (OR: 2.05; 95% CI: 1.05−4.03), swimming in sea/ocean < 12 months ago (OR: 1.63; 95% CI: 1.11−2.39), travelling to Africa (OR: 3.03; 95% CI: 1.23−7.46) or Asia (OR: 2.00; 95% CI: 1.02−3.90) < 12 months ago, and not changing kitchen towels daily (OR: 2.19; 95% CI: 1.24−3.87). The last had the largest population attributable risk (PAR) (47.5%). Eighty-four of 189 (44.4%) ESBL-E isolates carried blaCTX-M-15. Escherichia coli isolates belonged to 70 different sequence types (ST)s, of which ST131 (42/178 isolates; 23.6%) was most prevalent. Associations were observed between IncFIA plasmids and ST131 and blaCTX-M-27, and between IncI1 and ST88 and blaCTX-M-1. No CPE were detected. Conclusions The prevalence of ESBL-E carriage in the Netherlands’ community-dwelling population is 5.0%. Identified risk factors were mostly travelling (particularly to Asia and Africa) and kitchen hygiene. CPE were not detected.
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Affiliation(s)
- Gerrita van den Bunt
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht, the Netherlands
| | - Wilfrid van Pelt
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Laura Hidalgo
- Department of Medical Microbiology, University Medical Center Utrecht (UMCU), Utrecht, the Netherlands
| | - Jelle Scharringa
- Department of Medical Microbiology, University Medical Center Utrecht (UMCU), Utrecht, the Netherlands
| | - Sabine C de Greeff
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Anita C Schürch
- Department of Medical Microbiology, University Medical Center Utrecht (UMCU), Utrecht, the Netherlands
| | - Lapo Mughini-Gras
- Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Marc J M Bonten
- Department of Medical Microbiology, University Medical Center Utrecht (UMCU), Utrecht, the Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht, the Netherlands
| | - Ad C Fluit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht, the Netherlands
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Kwok KO, Chan E, Chung PH, Tang A, Wei WI, Zhu C, Riley S, Ip M. Prevalence and associated factors for carriage of Enterobacteriaceae producing ESBLs or carbapenemase and methicillin-resistant Staphylococcus aureus in Hong Kong community. J Infect 2020; 81:242-247. [PMID: 32447008 DOI: 10.1016/j.jinf.2020.05.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 04/07/2020] [Accepted: 05/17/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We conducted a cross-sectional study in Hong Kong community to estimate the carriage prevalence, associated factors and genotypes of extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E), methicillin-resistant Staphylococcus aureus (MRSA) and carbapenemase-producing Enterobacteriaceae (CPE). METHODS Seemingly healthy subjects were asked to provide nasal, handprint and stool samples from March to April 2017. Isolates were characterized by molecular methods. We used multivariable logistic regression models within a generalized estimating equation framework to identify risk factors for ESBL-E carriage. Characteristics of MRSA/CPE carriage were summarized. RESULTS The prevalence of ESBL-E, MRSA and CPE were 52.8% (104/197), 2.5% (5/197) and 0.5% (1/197) respectively. Most ESBL-E isolates were E. coli (85.6%; 113/132). Most ESBL genes belonged to blaCTX-M-G9 (68.9%) and blaTEM (53.0%) types. Self-reported antibiotic consumption (≥2 courses) in the past six months was associated with ESBL-E carriage (adjusted odds ratio: 4.71-5.47). CONCLUSIONS Abundance of ESBL-E in the community are causes of concern, and antibiotic use is associated with its carriage. Presence of MRSA and CPE in community members without clear healthcare exposure hints on a change in their epidemiology. This study establishes a baseline to formulate infection control policies and future studies in combating antimicrobial resistance.
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Affiliation(s)
- Kin-On Kwok
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China; Shenzhen Research Institute of The Chinese University of Hong Kong, Shenzhen, China.
| | - Emily Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Pui-Hong Chung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Arthur Tang
- Department of Software, Sungkyunkwan University, Seoul, Republic of Korea
| | - Wan-In Wei
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Chendi Zhu
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Steven Riley
- MRC Centre for Outbreak Analysis and Modelling, Department for Infectious Disease Epidemiology, Imperial College London, United Kingdom
| | - Margaret Ip
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, China
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Yamanaka T, Funakoshi H, Kinoshita K, Iwashita C, Horikoshi Y. CTX-M group gene distribution of extended spectrum beta-lactamase-producing Enterobacteriaceae at a Japanese Children's hospital. J Infect Chemother 2020; 26:1005-1007. [PMID: 32586731 DOI: 10.1016/j.jiac.2020.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 11/17/2022]
Abstract
Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae have spread globally as one of the most common multidrug resistant organisms. Although a wide variety of ESBL genes were known in each geographical region, few reports existed on the distribution of ESBL genes in Japanese children. To clarify the distribution of ESBL genes, we investigated the CTX-M type of the ESBL-producing Enterobacteriaceae and patient characteristics among hospital-acquired and community-acquired cases. Total of 253 isolates of ESBL-producing Enterobacteriaceae were recovered from 238 pediatric patients. ESBL-producing Enterobacteriaceae were mostly recovered from children with underlying diseases (76.5%). Ratio of community-acquired and hospital-acquired cases was 58.8% and 41.2%, respectively. Compared to the hospital-acquired cases, community-acquired cases had younger age, fewer underlying diseases, and the dominant detection of Escherichia coli. The most common ESBL-producing Enterobacteriaceae was E. coli (79.8%), followed by Klebsiella pneumoniae (9.1%). CTX-M9 group was the most prevalent CTX-M group gene (63.2%), which was dominantly detected in E. coli (72.7%). This was the largest descriptive study to find CTX-M9 group as the most prevalent ESBL genotype among Enterobacteriaceae isolated from Japanese children in line with adult's epidemiology.
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Affiliation(s)
- Takayuki Yamanaka
- Department of Pediatrics Niigata City General Hospital, Niigata, Japan; Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan.
| | - Hanako Funakoshi
- Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Kazue Kinoshita
- Division of Molecular Laboratory, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Chinami Iwashita
- Division of Microbiology, Department of Laboratory, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Yuho Horikoshi
- Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
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Willems RPJ, van Dijk K, Ket JCF, Vandenbroucke-Grauls CMJE. Evaluation of the Association Between Gastric Acid Suppression and Risk of Intestinal Colonization With Multidrug-Resistant Microorganisms: A Systematic Review and Meta-analysis. JAMA Intern Med 2020; 180:561-571. [PMID: 32091544 PMCID: PMC7042870 DOI: 10.1001/jamainternmed.2020.0009] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Acid suppressants inhibit gastric acid secretion and disrupt the intestinal microbiome. Whether acid suppression increases the risk of colonization with multidrug-resistant microorganisms (MDROs) is unclear. OBJECTIVES To systematically examine the association of use of acid suppressants with the risk of colonization with MDROs and to perform a meta-analysis of current evidence. DATA SOURCES PubMed, Embase, the Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials were searched from database inception through July 8, 2019. STUDY SELECTION Study selection was performed independently by 2 authors (R.P.J.W. and C.M.J.E.V.-G.) on the basis of predefined selection criteria; conflicts were resolved by consensus or by an adjudicator (K.v.D.). Human observational studies (case control, cohort, and cross-sectional) and clinical trial designs were selected if they quantified the risk of MDRO colonization in users of acid suppressants in comparison with nonusers. DATA EXTRACTION AND SYNTHESIS The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) recommendations were followed. Data were extracted independently by the same 2 authors, and adjudication was conducted when necessary. Risk of bias was assessed according to a modified Newcastle-Ottawa Scale. Pooled odds ratios (ORs) were estimated using random-effects models; heterogeneity was evaluated using the I2 method. MAIN OUTCOMES AND MEASURES The primary outcome measure was intestinal colonization with MDROs of the Enterobacterales order (producing extended-spectrum β-lactamases, carbapenemases, or plasmid-mediated AmpC β-lactamases), vancomycin-resistant enterococci, methicillin-resistant or vancomycin-resistant Staphylococcus aureus, or multidrug-resistant Pseudomonas or Acinetobacter species. RESULTS A total of 26 observational studies including 29 382 patients (11 439 [38.9%] acid suppressant users) met the selection criteria. Primary meta-analysis of 12 studies including 22 305 patients that provided adjusted ORs showed that acid suppression increased the odds of intestinal carriage of MDROs of the Enterobacterales order and of vancomycin-resistant enterococci by roughly 75% (OR = 1.74; 95% CI, 1.40-2.16; I2 = 68%). The odds were concordant with the secondary pooled analysis of all 26 studies (OR = 1.70; 95% CI, 1.44-1.99; I2 = 54%). Heterogeneity was partially explained by variations in study setting and the type of acid suppression. CONCLUSIONS AND RELEVANCE Acid suppression is associated with increased odds of MDRO colonization. Notwithstanding the limitations of observational studies, the association is plausible and is strengthened by controlling for confounders. In view of the global increase in antimicrobial resistance, stewardship to reduce unnecessary use of acid suppressants may help to prevent MDRO colonization.
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Affiliation(s)
- Roel P J Willems
- Amsterdam Infection and Immunity Institute, Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Karin van Dijk
- Amsterdam Infection and Immunity Institute, Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Johannes C F Ket
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Christina M J E Vandenbroucke-Grauls
- Amsterdam Infection and Immunity Institute, Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Fecal Carriage of Extended-Spectrum-β-Lactamase/AmpC-Producing Escherichia coli in Horses. Appl Environ Microbiol 2020; 86:AEM.02590-19. [PMID: 32033947 DOI: 10.1128/aem.02590-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/29/2020] [Indexed: 12/16/2022] Open
Abstract
A nationwide study on the occurrence of extended-spectrum β-lactamase (ESBL)/AmpC in nonhospitalized horses in the Netherlands was performed. Molecular characterization was done, and questionnaires were analyzed to identify factors associated with carriage. In total, 796 horse owners were approached; 281 of these submitted a fecal sample from their horse(s), resulting in 362 samples. All samples were cultured qualitatively in Luria-Bertani (LB) broth and subsequently on MacConkey agar, both supplemented with 1 mg/liter cefotaxime (LB+ and MC+). Positive samples were subsequently cultured quantitatively on MC+. Initial extended-spectrum-β-lactamase (ESBL)/AmpC screening was performed by PCR, followed by whole-genome sequencing on selected strains. Associations between ESBL/AmpC carriage and questionnaire items were analyzed using a univariate generalized estimating equation (GEE) regression analysis, followed by a multiple GEE model for relevant factors. In total, 39 of 362 samples (11%) were determined to be positive for ESBL/AmpC. bla CTX-M-1-carrying isolates were obtained from 77% of positive samples (n = 30). Other ESBL/AmpC genes observed included bla CTX-M-2, bla CTX-M-14, bla CTX-M-15, bla CTX-M-32, bla SHV-12, bla CMY-2, and bla ACT-10 A high association between the presence of bla CTX-M-1 and IncHI1 plasmids was observed (46% of samples; n = 18). Based on core genome analysis (n = 48 isolates), six Escherichia coli clusters were identified, three of which represented 80% of the isolates. A negative association between ESBL/AmpC carriage and horses being in contact with other horses at a different site was observed. The presence of a dog on the premises and housing in a more densely human-populated region were positively associated.IMPORTANCE Extended-spectrum β-lactamases (ESBLs) are widespread in human and animal populations and in the environment. Many different ESBL variants exist. The dissemination of ESBLs within and between populations and the environment is also largely influenced by genetic mobile elements (e.g., plasmids) that facilitate spread of these ESBLs. In order to identify potential attributable ESBL sources for, e.g., the human population, it is important to identify the different ESBL variants, the bacteria carrying them, and the potential risk factors for ESBL carriage from other potential sources. This nationwide study focuses on ESBL carriage in the open horse population and investigated the molecular characteristics, geographical distribution throughout the Netherlands, and potential risk factors for fecal ESBL carriage in horses. These data can be used for future attribution studies in order to reduce potential transmission of ESBL-producing bacteria between sources.
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