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

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.

Antibiotic Resistance Pattern of Extended Spectrum Beta Lactamase Producing Escherichia coli Isolated From Patients With Urinary Tract Infection in Morocco

“…Their incidence rate in urinary tract infection was 75%. However, an increase in the number of ESBL-EC is well described in different regions of the world ( Fernando et al., 2017 ; Rajabnia et al., 2019 ; Rohde et al., 2020 ).…”

A Novel Structure Harboring blaCTX-M-27 on IncF Plasmids in Escherichia coli Isolated from Swine in China

“…Additionally, bla CTX-M-27 has been detected as increasing rapidly in prevalence [1]. The detection of CTX-M-27 in Escherichia coli patient isolates has been increasing, and is especially alarming because of its presence in clonal groups such as ST10, ST69 and ST131 [3][4][5][6]. In particular, E. coli ST131 isolates are the primary hosts responsible for CTX-M-27 transmission in E. coli from companion animals, the environment, farm animals and animal products [3,[7][8][9][10][11][12][13].…”

Drug susceptibility and molecular epidemiology of Escherichia coli in bloodstream infections in Shanxi, China

“…It is noteworthy that bla CTX-M were strongly associated with ST131 (80% carried bla CTX-M ). We found that bla CTX-M-14 was the predominant bla CTX-M , followed by bla CTX-M-15 and bla CTX-M-55 , while in Germany, bla CTX-M-15 was the most common and bla CTX-M-14 was the second most frequently identified genotype ( Rohde et al, 2020 ). CTX-M-55, a variant of CTX-M-15 that contains a substitution of A80V within the β-lactamase possessing enhanced cephalosporin-hydrolyzing activity, was rarely found in clinical isolates previously ( Liao et al, 2017 ; Zhang et al, 2019 ).…”