Detection of Healthcare-Related Extended-Spectrum Beta-Lactamase-Producing Escherichia coli Transmission Events Using Combined Genetic and Phenotypic Epidemiology

Abstract

BackgroundSince the year 2000 there has been a sharp increase in the prevalence of healthcare-related infections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. However, the high community prevalence of ESBL-producing E. coli isolates means that many E. coli typing techniques may not be suitable for detecting E. coli transmission events. Therefore, we investigated if High-throughput MultiLocus Sequence Typing (HiMLST) and/or Raman spectroscopy were suitable techniques for detecting recent E. coli transmission events.MethodsThis study was conducted from January until December 2010 at Erasmus University Medical Center, Rotterdam, the Netherlands. Isolates were typed using HiMLST and Raman spectroscopy. A genetic cluster was defined as two or more patients carrying identical isolates. We used predefined definitions for epidemiological relatedness to assess healthcare-related transmission.ResultsWe included 194 patients; strains of 112 patients were typed using HiMLST and strains of 194 patients were typed using Raman spectroscopy. Raman spectroscopy identified 16 clusters while HiMLST identified 10 clusters. However, no healthcare-related transmission events were detected. When combining data from both typing techniques, we identified eight clusters (n = 34 patients), as well as 78 patients with a non-cluster isolate. However, we could not detect any healthcare-related transmission in these 8 clusters.ConclusionsAlthough clusters were genetically detected using HiMLST and Raman spectroscopy, no definite epidemiological relationships could be demonstrated which makes the possibility of healthcare-related transmission events highly unlikely. Our results suggest that typing of ESBL-producing E. coli using HiMLST and/or Raman spectroscopy is not helpful in detecting E. coli healthcare-related transmission events.

Multi-site implementation of whole genome sequencing for hospital infection control: A prospective genomic epidemiological analysis

“…Epidemiologic data were then compared for patients above the screening thresholds (‘genomically related’) within ST (or ST131 E. coli subclades). Patient pairs were classified according to a modification of previously published definitions 23 as ‘probable transmission’ if on the same ward at the same time, ‘possible transmission’ if admitted to the same ward at a different time (within 60 days), or admitted to the same hospital at the same time; all other patients were classified as ‘unlikely transmission’. Statistical analyses were performed using Stata v16.…”

High Prevalence of Intra-Familial Co-colonization by Extended-Spectrum Cephalosporin Resistant Enterobacteriaceae in Preschool Children and Their Parents in Dutch Households

“…Several studies in the Netherlands have reported the predominance of bla CTX−M genes in ESC R Enterobacteriaceae , mostly Escherichia coli , among hospital and primary care patients (van der Bij et al, 2011 ; Voets et al, 2012 ; Reuland et al, 2013 ), nursing home residents (Willemsen et al, 2015 ) and humans in the community (van Hoek et al, 2015 ; van den Bunt et al, 2016 ). Among them, E. coli belonging to sequence types (ST)10, ST38, ST69 and ST131 recovered from Dutch individuals have been recently associated with ESC R phenotype (Leverstein-van Hall et al, 2011 ; Overdevest et al, 2011 , 2015 ; van der Bij et al, 2011 ; Voets et al, 2012 ; Reuland et al, 2013 , 2016 ; Huijbers et al, 2014 ; Dohmen et al, 2015 ; van Hoek et al, 2015 ; Willemsen et al, 2015 ; Souverein et al, 2016 ; Voor in 't holt et al, 2016 ). However, data regarding the genetic background, plasmid replicon types and Insertion Sequence (IS) of ESBL/AmpC genes and their plasmid-mediated dissemination among the Dutch human population have been scarcely investigated.…”

Use of the quantitative antibiogram method for assessing nosocomial transmission of ESBL-producing Enterobacterales in a French hospital

“…Thus, the QA method alone does not appear to be suitable to assess reliable discrimination in ESBL-producing isolates and detect CTE. This point has already been reported previously for other methods like high-throughput MLST or Raman spectroscopy [27]. To improve methodology, we decided to combine both methods with epidemiological criteria.…”