Natural history and decolonization strategies for ESBL/carbapenem-resistant Enterobacteriaceae carriage: systematic review and meta-analysis

Bar-Yoseph, Haggai; Hussein, Khetam; Braun, Eyal; Paul, Mical

doi:10.1093/jac/dkw221

Cited by 150 publications

(127 citation statements)

References 58 publications

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“…This difference may have several reasons. First, ESBL prevalence may vary between regions and over time, and natural eradication of resistant Enterobacteriaceae might occur over time in the community (Bar-Yoseph et al, 2016). Additionally, samples included in this study were only chosen from patients without any gastrointestinal complaints, a factor which otherwise has been described to be associated with high ESBL prevalence (Reuland et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Extended-Spectrum β-Lactamase-Producing E. coli and Vancomycin-Resistant Enterococci in the Northern Dutch–German Cross-Border Region

et al. 2017

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Objectives: To reveal the prevalence and epidemiology of extended-spectrum β-lactamase (ESBL)- and/or plasmid AmpC (pAmpC)- and carbapenemase (CP) producing Enterobacteriaceae and vancomycin-resistant enterococci (VRE) across the Northern Dutch–German border region.Methods: A point-prevalence study on ESBL/pAmpC/CP producing Enterobacteriaceae and VRE was carried out in hospitalized patients in the Northern Netherlands (n = 445, 2012–2013) and Germany (n = 242, 2012). Healthy individuals from the Dutch community (n = 400, 2010–2012) were also screened. In addition, a genome-wide gene-by-gene approach was applied to study the epidemiology of ESBL-Escherichia coli and VRE.Results: A total of 34 isolates from 27 patients (6.1%) admitted to Dutch hospitals were ESBL/pAmpC positive and 29 ESBL-E. coli, three pAmpC-E. coli, one ESBL-Enterobacter cloacae, and one pAmpC-Proteus mirabilis were found. In the German hospital, 18 isolates (16 E. coli and 2 Klebsiella pneumoniae) from 17 patients (7.7%) were ESBL positive. In isolates from the hospitalized patients CTX-M-15 was the most frequently detected ESBL-gene. In the Dutch community, 11 individuals (2.75%) were ESBL/pAmpC positive: 10 ESBL-E. coli (CTX-M-1 being the most prevalent gene) and one pAmpC E. coli. Six Dutch (1.3%) and four German (3.9%) hospitalized patients were colonized with VRE. Genetic relatedness by core genome multi-locus sequence typing (cgMLST) was found between two ESBL-E. coli isolates from Dutch and German cross-border hospitals and between VRE isolates from different hospitals within the same region.Conclusion: The prevalence of ESBL/pAmpC-Enterobacteriaceae was similar in hospitalized patients across the Dutch–German border region, whereas VRE prevalence was slightly higher on the German side. The overall prevalence of the studied pathogens was lower in the community than in hospitals in the Northern Netherlands. Cross-border transmission of ESBL-E. coli and VRE seems unlikely based on cgMLST analysis, however continuous monitoring is necessary to control their spread and stay informed about their epidemiology.

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Section: Discussionmentioning

confidence: 99%

Epidemiology of Extended-Spectrum β-Lactamase-Producing E. coli and Vancomycin-Resistant Enterococci in the Northern Dutch–German Cross-Border Region

et al. 2017

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“…CPE carriage may resolve spontaneously, but in most cases it is likely to last >1 month. [9][10][11] While it is in a carrier's interest to be reassessed for continued carriage and removed from isolation if testing is negative, premature removal from isolation (ie, during the period when the patient is at ongoing risk of carriage) may result in cross transmission of CPE. Therefore, it is necessary to understand the causes of prolonged carriage, which lower the chances that CPE carrier status will be discontinued, and to define appropriate methods for discontinuing carrier status.…”

Section: Discontinuation Of Cpe Carrier Status In Known Carriersmentioning

confidence: 99%

Israeli National Policy for Carbapenem-Resistant Enterobacteriaceae Screening, Carrier Isolation and Discontinuation of Isolation

Solter

Adler

Rubinovitch

et al. 2017

Infect. Control Hosp. Epidemiol.

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abstract. Since 2006, Israel has been confronting an outbreak of carbapenem-resistant Enterobacteriaceae (CRE), and in 2007 Israel implemented a national strategy to contain spread. The intervention was initially directed toward acute-care hospitals and later expanded to include an established reservoir of carriage in long-term-care hospitals. It included regular reporting of CRE cases to a central registry and daily oversight of management of the outbreak at the institutional level. Microbiological methodologies were standardized in clinical laboratories nationwide. Uniform requirements for carrier screening and isolation were established, and a protocol for discontinuation of carrier status was formulated. In response to the evolving epidemiology of CRE in Israel and the continued need for uniform guidelines for carrier detection and isolation, the Ministry of Health in 2016 issued a regulatory circular updating the requirements for CRE screening, laboratory diagnosis, molecular characterization, and carrier isolation, as well as reporting and discontinuation of isolation in healthcare institutions nationwide. The principal elements of the circular are contained herein.

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“…Finally, the authors stated a persistence of carriage during the ICU-stay. A recent meta-analysis estimated a proportion of 76.7% of ESBL carriers to be still colonized at one month in healthcare settings [2]. This assumption is fairly realistic.…”

Section: The Study Of Gurieva Et Al In This Issue Of Clinical Infectimentioning

confidence: 99%

“…This gut reservoir is abundant, continue and dynamic and depends on tiers factors (i.e. comorbidities and the exposure to antibiotics), with a natural restoration of the normal flora over time [2]. In hospitals, MRE may be transmitted from patient-to-patient via staff hands, from the environment or event directly from person to person.…”

mentioning

confidence: 99%

Insight Into the Complex Epidemiology of Multidrug-Resistant Enterobacteriaceae

Birgand

Zahar

Lucet

2017

Clinical Infectious Diseases

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Natural history and decolonization strategies for ESBL/carbapenem-resistant Enterobacteriaceae carriage: systematic review and meta-analysis

Abstract: A significant proportion of ESBL and CRE carriers remain colonized up to 1 year in the healthcare setting. While short-term decolonization therapy reduces carriage during therapy, its longer-term effects are unclear.

Cited by 150 publications

References 58 publications

Epidemiology of Extended-Spectrum β-Lactamase-Producing E. coli and Vancomycin-Resistant Enterococci in the Northern Dutch–German Cross-Border Region

Epidemiology of Extended-Spectrum β-Lactamase-Producing E. coli and Vancomycin-Resistant Enterococci in the Northern Dutch–German Cross-Border Region

Israeli National Policy for Carbapenem-Resistant Enterobacteriaceae Screening, Carrier Isolation and Discontinuation of Isolation

Insight Into the Complex Epidemiology of Multidrug-Resistant Enterobacteriaceae

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