Faecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae is common 12 months after infection and is related to strain factors

Abstract

We aimed to determine the duration of faecal carriage of extended-spectrum β-lactamase (ESBL) -producing Enterobacteriaceae (EPE) in patients with clinical infection caused by an EPE, to study host strains during carriage, and to identify factors associated with prolonged carriage. Patients (n = 61) were followed with faecal samples and questionnaires about antimicrobial treatment and risk factors for EPE, 1, 3, 6 and 12 months after EPE infection. The EPE isolates were subjected to ESBL genotyping, epidemiological typing with pulsed-field gel electrophoresis and PCR-based replicon typing. Escherichia coli isolates were analysed with PCR for phylogrouping, detection of pabB (ST131) and virulence content. Patient-related and strain-related variables were compared for carriers and non-carriers at 12 months. Carriage of EPE was observed in 51 of 61 (84%) patients after 1 month, 36 of 61 (66%) after 3 months, 31 of 61 (55%) after 6 months and 26 of 61 (43%) after 12 months. Of the 26 carriers at 12 months, five had previous negative samples. In 17 of 61 patients, ESBL was found in a new bacterial species and/or strain during carriage. Among E. coli, 14 of 49 belonged to the international clone ST131. Phylogroup B2 and CTX-M-gr.-9 were associated with being carriers at 12 months (OR 4.3, 95% CI 1.1-16.3 and OR 6.4, 95% CI 1.3-30.9, respectively). In conclusion, EPE carriage is common 12 months after infection and persisting carriage may be associated with E. coli phylogroup B2 and CTX-M-gr.-9. The host strain frequently changes throughout carriage and negative samples do not imply eliminated carriage.

Long-Term Colonization by bla CTX-M -Harboring Escherichia coli in Healthy Japanese People Engaged in Food Handling

“…Moreover, some studies on the duration of fecal carriage of ESBL-producing bacteria in patients have been conducted in Thailand and Sweden (11)(12)(13). Titelman et al have noted that the fecal carriage of ESBL-producing Enterobacteriaceae in patients was common for 12 months after the time of initial infection (14). Information on the duration of fecal carriage of ESBL producers is important to determine how to deal with healthy carriers of ESBL producers at the time of their admission to hospitals.…”

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

“…23,24 However, instead of increased transmissibility, the duration of gastrointestinal colonization ESBL-E may play a role in the spread of these organisms. Titelman et al 25 showed that persisting carriage may be associated with E. coli phylogroup B2 (including all ST131 strains) and CTX-M-group 9. Prolonged duration of ST131 colonization is currently under investigation in our setting.…”

Duration of Contact Precautions for Acute-Care Settings

“…78 In a French university hospital, having the first positive culture on screening samples only (compared to clinical ± screening samples) was associated with ESBL-E clearance at readmission. 79 Similarly, among KPC-producing CRE carriers in a university hospital in Israel, the index culture being a clinical culture (vs surveillance culture) was associated with longer mean time to negativity.…”

“…[21][22][23][78][79][80][81][82][83][84][85][86][87][88][89][90] Most studies were conducted in the acute-care setting [21][22][23][79][80][81]83,85,87,[89][90][91] and identified a population of patients infected and/or colonized with MDR-E, either ESBL-E or CRE, or MDR-Enterobacteriaceae defined by resistance to multiple classes of drugs. Patients were assessed for persistence of colonization at study-specific intervals and variable durations of follow-up.…”