Prevalence, risk factors and genetic characterisation of extended-spectrum beta-lactamase and carbapenemase-producing Enterobacteriaceae (ESBL-E and CPE): a community-based cross-sectional study, the Netherlands, 2014 to 2016

Abstract

BackgroundThe epidemiology of carriage of extended-spectrum beta-lactamase-producing (ESBL-E) and carbapenemase-producing Enterobacteriaceae (CPE) in the general population is unknown.AimIn this observational study, the prevalence and risk factors for intestinal ESBL-E and CPE carriage in the Dutch general population were determined. ESBL-E were characterised.MethodsFrom 2014 to 2016, ca 2,000 residents were invited monthly to complete a questionnaire and provide a faecal sample, which was tested for ESBL-E. The first 1,758 samples were also tested for CPE. Risk factors for ESBL-E carriage were identified by multivariable logistic regression analysis. ESBL-E isolates underwent whole genome sequencing.ResultsOf 47,957 individuals invited, 4,177 (8.7%) completed the questionnaire and provided a faecal sample. ESBL-E were detected in 186 (4.5%) individuals, resulting in an adjusted prevalence of 5.0% (95% confidence interval (CI):3.4–6.6%). Risk factors were: born outside the Netherlands (odds ratio (OR): 1.99; 95% CI: 1.16−4.54), eating in restaurants > 20 times/year (OR: 1.70; 95% CI: 1.04−2.76), antibiotic use < 6 months ago (OR: 2.05; 95% CI: 1.05−4.03), swimming in sea/ocean < 12 months ago (OR: 1.63; 95% CI: 1.11−2.39), travelling to Africa (OR: 3.03; 95% CI: 1.23−7.46) or Asia (OR: 2.00; 95% CI: 1.02−3.90) < 12 months ago, and not changing kitchen towels daily (OR: 2.19; 95% CI: 1.24−3.87). The last had the largest population attributable risk (PAR) (47.5%). Eighty-four of 189 (44.4%) ESBL-E isolates carried bla CTX-M-15. Escherichia coli isolates belonged to 70 different sequence types (ST)s, of which ST131 (42/178 isolates; 23.6%) was most prevalent. Associations were observed between IncFIA plasmids and ST131 and bla CTX-M-27, and between IncI1 and ST88 and bla CTX-M-1. No CPE were detected.ConclusionsThe prevalence of ESBL-E carriage in the Netherlands’ community-dwelling population is 5.0%. Identified risk factors were mostly travelling (particularly to Asia and Africa) and kitchen hygiene. CPE were not detected.

Low occurrence of extended-spectrum cephalosporinase producing Enterobacteriaceae and no detection of methicillin-resistant coagulase-positive staphylococci in healthy dogs in Sweden

“…However, a Dutch study conducted in 2014-2016 used similar methods as the current study and they found that 10.6% of the 555 dogs carried ESBL-E [4]. In addition, they also reported that 3.8% of the owners were carriers, which was slightly lower than the 4.5% prevalence rate reported from the Dutch general population [4,14]. The carriage rate in Dutch citizens is comparable to 4.7% reported from Sweden in 2013 [15], so it is interesting to note the large difference between carriage rates in Dutch and Swedish dogs.…”

Seasonality in carriage of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in the general population: a pooled analysis of nationwide cross-sectional studies

“…Besides human-to-human transmission, potential routes of transmission of ESBL-E to humans are the food chain, direct contact with animals or indirectly via the environment [3]. The prevalence of the faecal carriage of ESBL-E in the general population in the Netherlands is approximately 5% [4–6].…”

“…From 2014 to 2017, the faecal carriage of ESBL-producing E. coli and K. pneumoniae was determined in three different large cross-sectional studies in the Netherlands in the selections of predominantly healthy individuals in the population at large: the Livestock Farming and Neighbouring Residents' Health Study (VGO) [5], the ESBL-population study (ESBLAT) [6] and a study on ESBL-producing bacteria among vegetarians and non-vegetarians (Vega Study) [16]. The VGO study was performed from February 2012 to May 2014 among the general population aged 18–70 years old living in a livestock-dense area in the south of the Netherlands, and after consent to participate in further studies, ESBL-E/K faecal carriage was assessed between February 2014 and May 2015 [5].…”

“…In the Vega Study, vegetarians and persons eating meat were actively contacted to submit faecal samples in order to study ESBL-E/K carriage between November 2015 and March 2017. More characteristics of the three studies are described in Table 1 and details of the respective studies and laboratory methods can be found in the cited references [5, 6, 16]. All individual level data of the three studies were combined into a new dataset in order to perform a pooled analysis.…”

Factors favouring the evolution of multidrug resistance in bacteria

“…One interpretation of this correlation is that the dissemination of resistance is favoured by poor sanitation. More convincingly, the individual carriage of extended-spectrum beta-lactamase-producing E. coli (an enzyme conferring resistance to beta-lactams antibiotics) was strongly associated with an indicator of poor hygiene in a large cohort [46]. However, it is not at all obvious in theory why transmission would favour resistance.…”