Emergence of carbapenem-resistant ST131 Escherichia coli carrying blaOXA-244 in Germany, 2019 to 2020

Welker, Sybille; Boutin, Sébastien; Miethke, Thomas; Heeg, Klaus; Nurjadi, Dennis

doi:10.2807/1560-7917.es.2020.25.46.2001815

Cited by 16 publications

(13 citation statements)

References 26 publications

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“…32 Worryingly, carbapenemase-producing E coli ST131 (mostly bla KPC and bla OXA-48-like ) have recently been reported from England and Germany. 33,34 In our study, ST131 strain H30R was most common, carrying predominantly bla CTX-M-14 and bla CTX-M-27 (ie, H30R1), whereas bla CTX-M-15 (associated with H30Rx strains) was less common. 25 Indeed, ST131 carrying bla CTX-M-27 has been suggested to be more transmissible than those with bla CTX-M-15 , which might explain its successful spread.…”

Section: Discussionmentioning

confidence: 53%

Molecular Epidemiology and Risk Factors for Extended-Spectrum β-Lactamase–Producing Enterobacterales in Long-Term Care Residents

Köhler

Seiffert

Kessler

et al. 2022

Journal of the American Medical Directors Association

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Objectives: We aimed to assess the burden of extended-spectrum b-lactamase (ESBL)-producing Enterobacterales in Swiss long-term care facilities (LTCFs) to describe the molecular epidemiology, describe the intrainstitutional and regional clusters of resistant pathogens, and identify independent institution-and resident-level factors associated with colonization. Design: Cross-sectional study. Setting and Participants: From August to October 2019, we performed a point prevalence study among residents from 16 LTCFs in Western and Eastern Switzerland (8 per region). Methods: Residents underwent screening for ESBL-producing Enterobacterales (ESBL-E); whole-genome sequencing (WGS) was performed. We gathered institution-level (eg, number of beds, staff-resident ratio, alcoholic hand rub consumption) and resident-level [eg, anthropometric data, time in facility, dependency, health care exposure, antibiotic treatment, proton-pump inhibitor (PPI) use] characteristics. Factors associated with colonization were identified using a generalized linear model. Results: Among 1185 eligible residents, 606 (51%) consented to the study. ESBL-E prevalence was 11.6% (70/606), ranging from 1.9% to 33.3% between institutions, with a median of 12.5% in the West and 6.9% in the East (P ¼ .03). Among 59 Escherichia coli (from 58 residents), multilocus sequence type (ST) 131 was most common (n ¼ 43/59, 73%), predominantly its subclone H30R1 (n ¼ 37/43, 86%). WGS data identified multiple intrainstitutional and regional clusters. Independent risk factors for ESBL carriage were previous ESBL colonization [adjusted odds ratio (aOR) 23.5, 95% confidence interval (CI) 6.6-83.8, P < .001), male gender (aOR 2.6, 95% CI 1.5-4.6, P ¼ .002), and use of PPIs (aOR 2.2, 95% CI 1.2-3.8, P ¼ .01). Conclusions and Implications: Overall ESBL-E prevalence in Swiss LTCF residents is low. Yet, we identified several clusters of residents with identical pathogens within the same institution. This implies that particularly affected institutions might benefit from targeted infection control interventions. PPI use was the only modifiable factor associated with carriage of ESBL producers. This study adds to the growing list

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Section: Discussionmentioning

confidence: 53%

Molecular Epidemiology and Risk Factors for Extended-Spectrum β-Lactamase–Producing Enterobacterales in Long-Term Care Residents

Köhler

Seiffert

Kessler

et al. 2022

Journal of the American Medical Directors Association

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“…The persistence of certain E. coli clones, sporadically carrying carbapenemases genes, warrants further careful surveillance. [ 30 ]…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of ESBL-producing Escherichia coli from repeated prevalence studies over 11 years in a long-term-care facility

Martischang

François

Cherkaoui

et al. 2021

Antimicrob Resist Infect Control

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Background Escherichia coli sequence type (ST) 131 H30 is an emerging multidrug resistant subclone, known to spread and cause outbreaks in long-term care facilities (LTCFs). Objectives and methods From 2010 through 2020, we performed 11 yearly surveillance studies for determining the prevalence of digestive carriage of ESBL-producing E. coli (ESBL-EC) among residents in a university-affiliated LCTF. Sequencing and genotyping of selected isolates were performed to characterize temporal trends in the prevalence and epidemic potential of ESBL-EC subclones, and for evaluating a potential rebound effect following discontinuation of contact precautions for ESBL-EC carriers in January 2019. Results This study included 2′403 LTCF residents, with 252 (10.5%) positive for ESBL-EC. Among the 236 ESBL-EC isolates available for typing, 58.0% belonged to the ST131 lineage, including 94/137 (68.6%) ST131 H30 isolates. An increasing yearly prevalence was observed for ESBL-EC (from 4.6 to 9.4%; p = 0.11), but not for the ST131 H30 subclone, which peaked in 2015 and declined thereafter. Multiple previously unnoticed ESBL-EC outbreaks occurred in the LTCF. Since 2018, we noted the clonal expansion of a rare ST131 H89 subclone (O16:H5) harboring CTX-M-14 and CTX-M-24. No rebound effect was observed in ESBL-EC prevalence nor in the different subclones following discontinuation of contact precautions for ESBL-EC carriers since 2019. Conclusion Clonal fluctuation was observed for ST131 H30 ESBL-EC with a current decline in prevalence. Surveillance should include the evolution of ST131 non-H30 subclones, which may spread in LTCFs. Our findings suggest that discontinuation of contact precautions for ESBL-EC carriers in LTCFs may be safely implemented, in support of European recommendations to limit ESBL-producing Enterobacteriaceae control measures in endemic settings to non-E. coli.

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“…The STs most frequently associated with carbapenemases in K. pneumoniae are ST258, which is predominant worldwide [ 8 ], and ST307, which is also associated with a higher mortality [ 9 ]. In Germany, it was reported that E. coli ST131 is a high-risk clone that should be monitored very closely [ 10 ], alongside ST38, located in various European countries [ 10 ]. In Spain, the STs most frequently associated with carbapenemases are ST11, 13, 15, 16, 101, 147, 340, 384, 388, 405, 437, 464, 512, 846 and 1235 [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

A Study in a Regional Hospital of a Mid-Sized Spanish City Indicates a Major Increase in Infection/Colonization by Carbapenem-Resistant Bacteria, Coinciding with the COVID-19 Pandemic

et al. 2021

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Bacterial resistance to antibiotics has proven difficult to control over the past few decades. The large group of multidrug-resistant bacteria includes carbapenemase-producing bacteria (CPB), for which limited therapeutic options and infection control measures are available. Furthermore, carbapenemases associate with high-risk clones that are defined by the sequence type (ST) to which each bacterium belongs. The objectives of this cross-sectional and retrospective study were to describe the CPB population isolated in a third-level hospital in Southern Spain between 2015 and 2020 and to establish the relationship between the ST and the epidemiological situation defined by the hospital. CPB were microbiologically studied in all rectal and pharyngeal swabs and clinical samples received between January 2015 and December 2020, characterizing isolates using MicroScan and mass spectrometry. Carbapenemases were detected by PCR and Sanger sequencing, and STs were assigned by multilocus sequence typing (MLST). Isolates were genetically related by pulsed-field gel electrophoresis using Xbal, Spel, or Apal enzymes. The episodes in which each CPB was isolated were recorded and classified as involved or non-involved in an outbreak. There were 320 episodes with CPB during the study period: 18 with K. pneumoniae, 14 with Klebisella oxytoca, 9 with Citrobacter freundii, 11 with Escherichia coli, 46 with Enterobacter cloacae, 70 with Acinetobacter baumannii, and 52 with Pseudomonas aeruginosa. The carbapenemase groups detected were OXA, VIM, KPC, and NDM with various subgroups. Synchronous relationships were notified between episodes of K. pneumoniae and outbreaks for ST15, ST258, ST307, and ST45, but not for the other CPB. There was a major increase in infections with CPB over the years, most notably during 2020, coinciding with the COVID-19 pandemic. This study highlights the usefulness of gene sequencing techniques to control the spread of these microorganisms, especially in healthcare centers. These techniques offer faster results, and a reduction in their cost may make their real-time application more feasible. The combination of epidemiological data with real-time molecular sequencing techniques can provide a major advance in the transmission control of these CPB and in the management of infected patients. Real-time sequencing is essential to increase precision and thereby control outbreaks and target infection prevention measures in a more effective manner.

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Emergence of carbapenem-resistant ST131 Escherichia coli carrying blaOXA-244 in Germany, 2019 to 2020

Cited by 16 publications

References 26 publications

Molecular Epidemiology and Risk Factors for Extended-Spectrum β-Lactamase–Producing Enterobacterales in Long-Term Care Residents

Molecular Epidemiology and Risk Factors for Extended-Spectrum β-Lactamase–Producing Enterobacterales in Long-Term Care Residents

Epidemiology of ESBL-producing Escherichia coli from repeated prevalence studies over 11 years in a long-term-care facility

A Study in a Regional Hospital of a Mid-Sized Spanish City Indicates a Major Increase in Infection/Colonization by Carbapenem-Resistant Bacteria, Coinciding with the COVID-19 Pandemic

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