Comparison of rates of fecal colonization with extended‐spectrum beta‐lactamase‐producing enterobacteria among patients in different wards, outpatients and medical students

Abstract

Because asymptomatic carriage of extended-spectrum beta-lactamase (ESBL) producers is a risk factor for infection, data on colonization dynamics are important when planning infection control. This study investigated fecal colonization with ESBL producers among inpatients, outpatients and medical students and compares the characteristics of ESBL producers among these groups. Carriage rates were investigated in 5581 fecal samples; 4343 from inpatients (330, 1397, 619 and 1864 from adult ICUs [intensive care units], adult non-ICUs, pediatric ICUs and pediatric non-ICUs, respectively), 814 from outpatients and 424 from screening of medical students. ESBL producers were characterized by co-resistance, integrons carried, and aminoglycoside resistance and ESBL genes. Dynamic regression models were built to identify relationships between combinations of time series of monthly antibiotic consumption, prevalence of carriers and infected subjects. Inpatients, ICU patients and adults showed higher prevalence than outpatients, non-ICU patients or children (7.4%, 9.3% and 12.0% vs. 3.1%, 6.1% and 4.1%, respectively). Klebsiella pneumoniae was more frequent in ICU patients; dominance of CTX-M-15 producers was more marked in adult than in pediatric inpatients. ESBL carriage was shown to be a consequence of infection in adults in the time-series analysis; antibiotic consumption had little effect. The epidemiology of colonization with ESBL producers differed between pediatric ICU, adult ICU and adult non-ICU patients. In adults, carriage of ESBL producers seems to be the consequence of infection, especially in ICU patients; the main source of colonization is nosocomial acquisition. In contrast, children are less likely to acquire colonizer strains in hospitals; importation of ESBL producers by colonized children seems to be significant.

Multidrug-resistant bacteria as intestinal colonizers and evolution of intestinal colonization in healthy university students in Portugal

“…Antibiotic resistant E. coli silent carriage has been described, with rates varying between 6 and 63 % in different parts of the world [8]. Particularly in university students, colonization by extended-spectrum beta lactamase (ESBL)producing bacteria have been described in Hungary (2,6 %), Sweden (7 %) and ESBL and/or AmpC in Mozambique (20 %) [6,9,10]. Previous antibiotic consumption and recent travel to countries with high antibiotic resistance rates have been associated with colonization, although the association with food, contact with animals and human patients, is not well known [2,11,12].…”

A One Health Comparative Assessment of Antimicrobial Resistance in Generic and Extended-Spectrum Cephalosporin-Resistant Escherichia coli from Beef Production, Sewage and Clinical Settings

“…Extended-spectrum β-lactam (ESBL) resistant E. coli are of particular public health concern [ 19 ] as they are able to inactivate most β-lactam antimicrobials [ 20 ] used to treat associated infections. Presently, ESBL bacteria are a common source of therapeutic failure due to frequent co-resistance to multiple last resort antimicrobials [ 21 , 22 ] including colistin (i.e., polymyxin E), aminoglycoside, and 3rd and 4th generation cephalosporins that are used to treat a significant proportion of nosocomial infections [ 23 , 24 , 25 ]. In veterinary and human medicine, the extended-spectrum cephalosporins which are a sub-class of ESBL are regarded as critically important [ 26 ].…”

ESBL-colonization at ICU admission: impact on subsequent infection, carbapenem-consumption, and outcome

“…[7][8][9] Colonization with ESBL-PE has been identified as an important risk factor for invasive infections with ESBL-PE, [10][11][12] and different studies have shown that ICU patients have a particularly high risk of ESBL-PE colonization. 13,14 To inform recommendations on empirical use of carbapenems in the ICU setting, strategies for identifying patients at risk for ESBL-PE are needed. Thus, screening ICU Patients for ESBL-PE carriage on admission is a logical strategy.…”