Prevalence and Risk Factors for Colonization With Extended-Spectrum Cephalosporin-ResistantEscherichia coliin Children Attending Daycare Centers: A Cohort Study in the Netherlands

Abstract

The distribution of ESC-R E coli types in DCCs differs from that of the general population. Extended-spectrum cephalosporin-resistant E coli carriage in DCC-attending children is associated with the hygiene policies enforced in the DCC. Although our results are not conclusive enough to change current DCC practice beyond ensuring compliance with standing policies, they generated hypotheses and defined the degree of ESC resistance among DCC attendees, which may influence empiric antibiotic therapy choices, and tracked the increasing trend in ESC resistance.

Attributable sources of community-acquired carriage of Escherichia coli containing β-lactam antibiotic resistance genes: a population-based modelling study

“…We used a simple transmission model to determine the basic reproduction number (R 0 ) in the open community, considering a 5% equilibrium prevalence of communityacquired ESBL-EC and pAmpC-EC, with and without assuming random mixing (eg, the household clustering effect; appendix pp 7-10). [8][9][10][11][12] Posterior quantities of interest from the Markov Chain Monte Carlo simulation were mean values and 95% Bayesian credible intervals (CrIs) of percent attributions. We also report SDs and median values of the posterior distribution.…”

“…Moreover, a Dutch study 16 on household transmission of ESBL-producing bacteria suggested that, although no single dominant acquisition route in the community exists, the estimated probability of transmission from an index patient to a household contact is 67%. Studies of children have also shown that the only factors predicting carriage of ESBL-producing and pAmpC-producing bacteria were related to hygiene and cleaning practices, 8,9 further indicating that anthroponotic transmission of ESBL-EC and pAmpC-EC contributes substantially to total transmissions. Our finding of a relatively large attributable fraction of ESBL-EC and pAmpC-EC recirculation in the open community led to a higher R 0 than previously estimated.…”

“…This finding would also explain the relatively stable ESBL-EC and pAmpC-EC prevalence of approximately 5% that has been repeatedly measured across the past two decades in the Netherlands. [8][9][10][11][12] To discern whether the nonhuman sources might act as natural boosts (eg, new intro ductions, possibly from abroad) to revive the baseline prevalence (which might not maintain itself with only human-to-human transmission), we need time-dependent source attri bution analyses based on longitudinal data.…”

“…Cross-sectional studies in the Netherlands report a prevalence of approximately 5% for ESBL-EC and pAmpC-EC intestinal carriage in the open community. [8][9][10][11][12] Because ESBL-EC and pAmpC-EC human infections are often preceded by asymptomatic carriage, 13 a crucial step towards breaking the transmission chain is to identify their sources. Here, we applied an established source attribution model based on nationally representative ESBL-EC and pAmpC-EC gene, prevalence, and human exposure data to quantify the relative contributions of several sources to community-acquired ESBL-EC and pAmpC-EC intestinal carriage in the Netherlands.…”

Low antimicrobial resistance in general practice patients in Rotterdam, the city with the largest proportion of immigrants in the Netherlands

“…The prevalence of ESBL among E. coli and K. pneumoniae in our study (3.6%) was comparable with the national data. Other studies reported prevalences ranging from 4.5 to 19.1% [18][19][20][21][22][23][24][25]. It should be noted, however, that these other studies have included populations that are not comparable with our patient population.…”