Prevalence and Spread of Multidrug Resistant Escherichia coli Isolates Among Nursing Home Residents in the Southern Part of the Netherlands

Donk, Christina F. M. van der; Schols, J.M.G.A.; Driessen, Caroline; Hagenouw, R.G.P.; Meulendijks, Audrey; Stobberingh, Ellen E.

doi:10.1016/j.jamda.2012.09.026

Cited by 21 publications

(18 citation statements)

References 27 publications

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“…In this study, ST131 was observed as the most prevalent sequence type, and ST131 was present in all NHs. 21 In theory, a culture on admission is needed to determine acquisition. However, in the Netherlands, the ESBL-E prevalence is low in hospitals as well as in the community.…”

Section: Discussionmentioning

confidence: 99%

Extensive Dissemination of Extended Spectrum β-Lactamase–Producing Enterobacteriaceae in a Dutch Nursing Home

Willemsen

Nelson

Hendriks

et al. 2015

Infect. Control Hosp. Epidemiol.

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objective. Risk factors for rectal carriage of ESBL-E and transmission were investigated in an outbreak of extended-spectrum β-lactamaseproducing Enterobacteriaceae (ESBL-E).design. Rectal carriage of ESBL-E was determined in a cross-sectional survey by culture of perianal swabs or fecal samples. Both phenotypical and genotypical methods were used to detect the production of ESBL. Nosocomial transmission was defined as the presence of genotypically related strains in ≥2 residents within the NH. Patient characteristics and variables in infection control practices were registered to investigate risk factors for transmission.setting. A nursing home (NH) in the southern Netherlands.participants. Of 189 residents, 160 residents (84.7%) were screened for ESBL-E carriage. Of these 160 residents, 33 (20.6%) were ESBL-E positive. ESBL carriage rates varied substantially between wards (range, 0-47%). Four different ESBL-E clusters were observed. A bla CTX-M1-15 positive E. coli ST131 constituted the largest cluster (n = 21) and was found in multiple wards (n = 7).results. Our investigation revealed extensive clonal dissemination of bla CTX-M1-15 -positive E. coli ST131 in a nursing home. Unexplained differences in ESBL prevalence were detected among the wards.conclusions. As NHs constitute potential sources of multidrug-resistant bacteria, it is important to gain a better understanding of the risks factors and routes of transmission of ESBL-E. 2015;36(4):394-400 Infections due to extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-E) are a major health concern worldwide. Infect Control Hosp Epidemiol1 Until the late 1990s, most ESBL-E were related to healthcare settings, typically Klebsiella pneumoniae, and predominantly carried mutant forms of the long-established TEM or SHV penicillinases. However, since the turn of the century, ESBL-Es have become widespread outside the hospital, and strains of Escherichia coli with CTX-M ESBL have become prominant. 2 The dissemination of some successful strains, such as E. coli sequence type ST131, often in the presence of CTX-M1-15 resistance genes, has been reported in association with healthcare settings and elderly hosts.3 Nursing homes (NHs) may become reservoirs of ESBL-producing Enterobacteriaceae (ESBL-E) because the residents frequently require medical care and antimicrobial therapy. 4,5 Residents colonized with ESBL-E in the gastrointestinal tract may serve as reservoirs for others. 6 Once resistance is present in an NH, resistant strains tend to persist and become endemic because the length of stay is much longer than in acute care hospitals and infection control practices are less stringent. 7A cross-sectional survey, performed in an NH in the southern Netherlands, revealed a high proportion of residents with rectal ESBL-E carriage. 8 The results of this survey were further investigated, and an outbreak of ESBL-E. coli sequence type ST131 was detected. We further investigated risk factors for rectal carriage of ESBL-E and transmission of the outbreak strain...

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Section: Discussionmentioning

confidence: 99%

Extensive Dissemination of Extended Spectrum β-Lactamase–Producing Enterobacteriaceae in a Dutch Nursing Home

Willemsen

Nelson

Hendriks

et al. 2015

Infect. Control Hosp. Epidemiol.

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“…Other epidemiologic and ecologic associations include ST131's predilection for elderly hosts and its high prevalence among longterm-care-facility (LTCF) residents in both the United States (20) and Europe (29)(30)(31)(32)(33)(34). Additionally, infections due to ESBL-positive ST131 have been associated with international travel (26,(35)(36)(37).…”

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confidence: 99%

A New Clone Sweeps Clean: the Enigmatic Emergence of Escherichia coli Sequence Type 131

Banerjee

Johnson

2014

Antimicrob Agents Chemother

215

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E scherichia coli sequence type 131 (ST131) is a recently emerged, extensively antimicrobial-resistant E. coli clonal group that has spread explosively throughout the world, driving the rapid increase in prevalence of antimicrobial resistance in E. coli (1-5). Such widespread expansion of a single clonal group is unprecedented in E. coli populations, although it has been seen in other antimicrobial-resistant pathogens such as methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus pneumoniae, and the NAP1 strain of Clostridium difficile (6, 7), and was foreshadowed by the notorious but less extensive expansion of E. coli "clonal group A" (8-10). Despite ST131 being recognized as a pandemic clonal group that threatens public health, ST131 has received comparatively less attention in the United States than have other antimicrobial-resistant pathogens. Here we review the epidemiology and molecular phylogeny of ST131, possible mechanisms for its ecological success, and implications of its widespread dissemination. EARLY STUDIES OF ST131 EPIDEMIOLOGY AND RESISTANCEST131, which is defined by the sequences of the 7 housekeeping genes that are commonly used for multilocus sequence typing (MLST) in E. coli according to the Achtman MLST scheme (http: //mlst.warwick.ac.uk/mlst/dbs/Ecoli), was first reported in 2008 by two research groups that were studying CTX-M-type extended-spectrum-beta-lactamase (ESBL)-producing E. coli (2, 11). By 2009, ST131 had been identified in 9 countries spanning 3 continents (3-5). ST131 belongs to (virulence-associated) E. coli phylogenetic group B2, and most isolates exhibit serotype O25b:H4, except for a small subset that are serotype O16:H5 (12) and rare variants with other serotypes (13). ST131 is associated with distinct combinations of extraintestinal virulence factors, compared with non-ST131 E. coli (4,(14)(15)(16)(17), and exhibits diverse pulsedfield gel electrophoresis (PFGE) profiles, several of which predominate globally (18).According to recent studies, the prevalence of ST131 among human clinical E. coli isolates varies by geographic region and host population, ranging overall from 12.5% (19) to nearly 30% (15, 20, 21) of E. coli clinical isolates. Like other extraintestinal pathogenic E. coli (ExPEC) strains, ST131 causes a variety of extraintestinal infections, including bacteremia, pneumonia, and urinary tract, intra-abdominal, and wound infections. Whether ST131 is associated with worse clinical outcomes than other E. coli strains is unclear, since some studies suggest that ST131 is more likely to cause persistent or recurrent urinary tract infections (20) or a higher frequency of sepsis (22), whereas others have found no difference in outcomes of infections with ST131 versus other E. coli strains (23, 24). In one study, patients infected with ST131 had persistent or recurrent symptoms in part because they received empirical therapy with fluoroquinolones (FQs), which are ineffective against most members of this clonal group (20).Regarding epidemiologi...

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“…16,25 As found in the study of urinary E. coli from 5 Dutch NHs, CipREc colonization varied by NH, 16 underscoring the possibility that interventions can reduce the occurrence and spread. Indeed, in the parent study for this analysis, there was a 23% decrease in the prevalence of all MDR bacteria among NHs assigned to a multimodal intervention by Mody et al, 18 although we found no statistically significant differences in mean CipREc carriage duration or acquisition rate between the 3 intervention and 2 control homes included here.…”

Section: Discussionmentioning

confidence: 93%

Long-Term Carriage of Ciprofloxacin-Resistant Escherichia coli Isolates in High-Risk Nursing Home Residents

Ismail

Luo

McNamara

et al. 2016

Infect. Control Hosp. Epidemiol.

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BACKGROUND Rates of multidrug-resistant gram-negative organisms are surpassing those of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci in nursing homes (NHs). OBJECTIVE To characterize the incidence and duration of carriage of ciprofloxacin-resistant Escherichia coli (CipREc) in NHs and identify those in the O25b-ST131 lineage. METHODS We collected 227 CipREc isolates obtained by routine and regular surveillance of high-risk NH residents with indwelling devices. Repetitive element palindromic (REP)–polymerase chain reaction assay and multiplex polymerase chain reaction amplification for O25b-ST131 E. coli detection were performed using (GTG)5-primers and O25pabBspe and trpA2 primer pairs, respectively. RESULTS We found a high period prevalence of CipREc colonization (21.5%), high rates of recolonization with the same strain following clearing (0.46 recolonizations/person/year), and an acquisition incidence of 1.05 cases/1,000 person-days. Almost three-quarters of colonized residents carried strains in the O25b-ST131 E. coli lineage. Compared with isolates not in the lineage, O25b-ST131 isolates were carried significantly longer (10 vs 3 months). We identified 18 different REP-types; 2 occurred in 55% of the residents colonized with CipREc, and in more than 1 NH. Duration of CipREc carriage varied by REP-type and averaged 6 months. CONCLUSION CipREc occurred frequently in NH residents and is carried for long durations, and reacquisition following clearance is common. Trial registration. ClinicalTrials.gov identifier: NCT01062841.

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Prevalence and Spread of Multidrug Resistant Escherichia coli Isolates Among Nursing Home Residents in the Southern Part of the Netherlands

Cited by 21 publications

References 27 publications

Extensive Dissemination of Extended Spectrum β-Lactamase–Producing Enterobacteriaceae in a Dutch Nursing Home

Extensive Dissemination of Extended Spectrum β-Lactamase–Producing Enterobacteriaceae in a Dutch Nursing Home

A New Clone Sweeps Clean: the Enigmatic Emergence of Escherichia coli Sequence Type 131

Long-Term Carriage of Ciprofloxacin-Resistant Escherichia coli Isolates in High-Risk Nursing Home Residents

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