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

Abstract

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...

Prevalence and transmission dynamics of Escherichia coli ST131 among contacts of infected community and hospitalized patients

“…On the other hand, it seems that standard precautions in hospitals prevent the transmission of ST131 in most cases; this is also consistent with studies that found low rates of ESBL-producing E. coli transmission among hospitalized patients, even when contact precautions were not used [23,24]. Studies focused on ESBL producers (including isolates belonging to ST131) in nursing homes suggested that behaviour was more like households than hospitals [25]. A mathematical model showed that avoiding person-to-person transmission was more efficacious than reducing exposure to antibiotics [26].…”

Extraintestinal PathogenicEscherichia coli, a Common Human Pathogen: Challenges for Vaccine Development and Progress in the Field

“…The H30 subclone is the most prevalent MDR subclone among nosocomial ExPEC infections [ 33 ]. Hospital outbreaks of ST131 strains have been described with evidence of potential for wide dissemination among inpatients and residents of long-term care facilities [ 34 ].…”

High Prevalence of Intra-Familial Co-colonization by Extended-Spectrum Cephalosporin Resistant Enterobacteriaceae in Preschool Children and Their Parents in Dutch Households

“…Several studies in the Netherlands have reported the predominance of bla CTX−M genes in ESC R Enterobacteriaceae , mostly Escherichia coli , among hospital and primary care patients (van der Bij et al, 2011 ; Voets et al, 2012 ; Reuland et al, 2013 ), nursing home residents (Willemsen et al, 2015 ) and humans in the community (van Hoek et al, 2015 ; van den Bunt et al, 2016 ). Among them, E. coli belonging to sequence types (ST)10, ST38, ST69 and ST131 recovered from Dutch individuals have been recently associated with ESC R phenotype (Leverstein-van Hall et al, 2011 ; Overdevest et al, 2011 , 2015 ; van der Bij et al, 2011 ; Voets et al, 2012 ; Reuland et al, 2013 , 2016 ; Huijbers et al, 2014 ; Dohmen et al, 2015 ; van Hoek et al, 2015 ; Willemsen et al, 2015 ; Souverein et al, 2016 ; Voor in 't holt et al, 2016 ). However, data regarding the genetic background, plasmid replicon types and Insertion Sequence (IS) of ESBL/AmpC genes and their plasmid-mediated dissemination among the Dutch human population have been scarcely investigated.…”