ESBL colonization and acquisition in a hospital population: The molecular epidemiology and transmission of resistance genes

Abstract

A prospective cohort study (German Clinical Trial Registry, No. 00005273) was performed to determine pre-admission colonization rates, hospital acquisition risk factors, subsequent infection rates and colonization persistence including the respective molecular epidemiology and transmission rates of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (EPE). A total of 342 EPEs were isolated from rectal swabs of 1,334 patients on admission, at discharge and 6 months after hospitalization. Inclusion criteria were patients’ age > 18 years, expected length of stays > 48 hours, external referral. The EPEs were characterized by routine microbiological methods, a DNA microarray and ERIC-PCR. EPE colonization was found in 12.7 % of admitted patients, with the highest rate (23.8 %) in patients from nursing homes. During hospitalization, 8.1 % of the patients were de novo EPE colonized, and invasive procedures, antibiotic and antacid therapies were independent risk factors. Only 1/169 patients colonized on admission developed a hospital-acquired EPE infection. Escherichia coli was the predominant EPE (88.9 %), and 92.1% of the ESBL phenotypes could be related to CTX-M variants with CTX-M-1/15 group being most frequent (88.9%). A corresponding β-lactamase could not be identified in five isolates. Hospital-acquired EPE infections in patients colonized before or during hospitalization were rare. The diversity of the EPE strains was much higher than that of the underlying plasmids. In seven patients, transmission of the respective plasmid across different species could be observed indicating that the current strain-based surveillance approaches may underestimate the risk of inter-species transmission of resistance genes.

Evaluation of the Association Between Gastric Acid Suppression and Risk of Intestinal Colonization With Multidrug-Resistant Microorganisms

“…Őstholm-Balkhed et al, 2013 48 Prasad et al, 2016 49 Goodman et al, 2019 36 Hagel et al, 2019 42 Kuenzli et al, 2014 44 Lee et al, 2018 46 1 Subtotal (95% CI) Heterogeneity: τ 2 = 0.04; χ 2 = 8.68, df = 6 (P = .19); I 2 = 31% Test for overall effect: z = 4.74 (P<.001)…”

“…We divided the 15 hospital-based studies into 2 groups: 4 studies 9,36,37,43 evaluated colonization at admission (sc reening w ithin 48 hours of admission), and 11 studies 15,[38][39][40][41][42]46,47,50,52,53 I 2 = 33%); 4 community-based studies 10,51,54,57 showed similar results but with a slightly smaller association (OR = 1.41; 95% CI, 1.07-1.87; I 2 = 21%). However, meta-analysis of 4 travelbased studies 8,44,48,56 yielded an OR with a very broad CI (OR = 1.11; 95% CI, 0.82-1.50; I 2 = 0%) (eFigure 4 in the Supplement).…”

“…Hagel et al, 2019 42 Kuenzli et al, 2014 44 Lee et al, 2018 46 Rodríguez-Baño et al, 2008 51 Vading et al, 2016 56 Őstholm-Balkhed et al, 2013 48 Subtotal (95% CI) Heterogeneity: τ 2 = 0.00; χ 2 = 4.83, df = 5 (P = .44); I 2 = 0 Test for overall effect: z = 0.91 (P = .36) Total (95% CI) Heterogeneity: τ 2 = 0.03; χ 2 = 20.39, df = 13 (P = .09); I 2 = 36% Test for overall effect: z Ben-Ami et al, 2006 37 Hamprecht et al, 2016 43 Huizinga et al, 2017 9 Latour et al, 2019 45 Reuland et al, 2016 10 Søgaard et al, 2017 54 Wielders et al, 2017 57 Subtotal (95% CI) Heterogeneity: τ 2 = 0.04; χ 2 = 15.42, df = 7 (P = .03); I 2 = 55% Test for overall effect: z Okamoto et al, 2017 15 Prasad et al, 2016 49 Seekatz et al, 2018 52…”

Screening for multi-drug-resistant Gram-negative bacteria: what is effective and justifiable?

“…This means that resistance traits can be transferred from individual bacteria to other individual bacteria, and in rare cases even between species (Bosch et al 2017;Lindblom et al 2019). Consequently, to the extent that individuals develop symptoms by resistant bacteria due to an MDRGN colonisation, these may not be the bacteria targeted by screening, but rather from other bacteria in their gut adopting the same plasmid (Hagel et al 2019). A potentially effective program would therefore have to focus not on particular drug resistant bacteria types, but also on the resistant mechanism for early identification of polyclonal outbreaks that may involve interspecies plasmid migration (Müller et al 2016).…”

Molecular characterization of Enterobacteriaceae producing β-lactamase and methicillin-resistant staphylococci isolated from the hospital environment and catheters in two public hospitals in Benin

“…Most bacterial species are able to integrate different determinants of resistance into their genome. Thus, the dissemination of resistance genes between bacteria has led to the appearance of bacteria resistant to several antibiotics in particular the strains of Staphylococcus aureus resistant to methicillin (MRSA), the enterobacteria producing betaextended spectrum lactamases (ESBL) and vancomycin resistant enterococci (VRE) [8,9,10]. Among bacteria resistant to antibiotics, enterobacteria producing broad spectrum β-lactamase (ESBL) represent a major global threat in hospitals [8].…”