Epidemiology of ESBL-producing Escherichia coli from repeated prevalence studies over 11 years in a long-term-care facility

Abstract

Background Escherichia coli sequence type (ST) 131 H30 is an emerging multidrug resistant subclone, known to spread and cause outbreaks in long-term care facilities (LTCFs). Objectives and methods From 2010 through 2020, we performed 11 yearly surveillance studies for determining the prevalence of digestive carriage of ESBL-producing E. coli (ESBL-EC) among residents in a university-affiliated LCTF. Sequencing and genotyping of selected isolates were performed to characterize temporal trends in the prevalence and epidemic potential of ESBL-EC subclones, and for evaluating a potential rebound effect following discontinuation of contact precautions for ESBL-EC carriers in January 2019. Results This study included 2′403 LTCF residents, with 252 (10.5%) positive for ESBL-EC. Among the 236 ESBL-EC isolates available for typing, 58.0% belonged to the ST131 lineage, including 94/137 (68.6%) ST131 H30 isolates. An increasing yearly prevalence was observed for ESBL-EC (from 4.6 to 9.4%; p = 0.11), but not for the ST131 H30 subclone, which peaked in 2015 and declined thereafter. Multiple previously unnoticed ESBL-EC outbreaks occurred in the LTCF. Since 2018, we noted the clonal expansion of a rare ST131 H89 subclone (O16:H5) harboring CTX-M-14 and CTX-M-24. No rebound effect was observed in ESBL-EC prevalence nor in the different subclones following discontinuation of contact precautions for ESBL-EC carriers since 2019. Conclusion Clonal fluctuation was observed for ST131 H30 ESBL-EC with a current decline in prevalence. Surveillance should include the evolution of ST131 non-H30 subclones, which may spread in LTCFs. Our findings suggest that discontinuation of contact precautions for ESBL-EC carriers in LTCFs may be safely implemented, in support of European recommendations to limit ESBL-producing Enterobacteriaceae control measures in endemic settings to non-E. coli.

Intestinal colonization with multidrug-resistant Enterobacterales: screening, epidemiology, clinical impact, and strategies to decolonize carriers

“…People residing in chronic care facilities are at increased risk of gut colonization with MDROs, but the estimated prevalence varies between countries [71,72]. For instance, in Switzerland (2010-2020), 10.5% of the long-term care facilities (LTCF) residents were colonized with ESBL-Ec, of which 58% belonged to the pandemic sequence type (ST) 131 lineage [73]. Consistent results were obtained in a more recent national Swiss study (2019), with an ESBL-Ent carriage of 11.6% and again a high prevalence of ST131 Ec strains [74].…”

Impact of COVID-19 pandemic on multidrug resistant gram positive and gram negative pathogens: A systematic review

“…This review also demonstrated that most of the studies reported a decline in the prevalence of ESBL-producing E. coli and ESBL-producing K. pneumoniae during COVID-19 pandemic. This is in contrast to the rising trend of ESBL-producing Enterobacteriaceae infections prior to the COVID-19 pandemic [62] , [63] . This implies that there was a reduction in the prevalence of ESBL-producing Enterobacteriaceae during the COVID-19 pandemic.…”

Genomic characterization of multidrug-resistant extended spectrum β-lactamase-producingKlebsiella pneumoniaefrom clinical samples of a tertiary hospital in South Kivu Province, eastern Democratic Republic of Congo

“…According to data from Asia, Latin America, Europe, and Africa, the dramatic increase in third-generation cephalosporin resistance in Enterobacteriaceae is mainly due to the spread of bla-CTXM-15 ESBL (3)(4)(5),with bla CTXM-15 being the most common ESBL gene worldwide (6,7). While most studies of MDR ESBL-producing Enterobacteriaceae have focused on Escherichia coli (8)(9)(10)(11)(12)(13)(14)(15), few studies have characterized the whole genome of MDR ESBL-producing Klebsiella pneumoniae, even though this agent is one of the most widespread MDR ESBL-producing Enterobacteriaceae associated with extra-intestinal infections both in hospital and community settings (16)(17)(18)(19)(20)(21). Moreover, several strains of K. pneumoniae have been linked to multinational epidemics all over the world (21,22).…”