Prevalence, genetic diversity of and factors associated with ESBL-producing Enterobacterales carriage in residents of French nursing homes

Broussier, Marion; Gbaguidi‐Haore, Houssein; Rachidi-Berjamy, F.; Bertrand, Xavier; Slekovec, C.

doi:10.1016/j.jhin.2019.12.008

Cited by 12 publications

(11 citation statements)

References 26 publications

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“…Spread of ESBLeE coli ST131 in LTCFs has been described from many countries. 6,31 Its success has been partly attributed to the longer carriage time compared to other STs. 32 Worryingly, carbapenemase-producing E coli ST131 (mostly bla KPC and bla OXA-48-like ) have recently been reported from England and Germany.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 As a consequence, these high-risk clones are often responsible for socalled clustering of cases (ie, detection of identical pathogens within different residents in a particular institution) within LTCFs. 6 In general, compared to infections with their sensitive counterparts, infections due to resistant pathogens are associated with prolonged length of hospital stay and even with increased mortality in some studies. 7e9 One factor complicating the management of these infections is that identified pathogens often remain susceptible to only intravenously administered substances.…”

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confidence: 99%

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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: 99%

mentioning

confidence: 99%

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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“…Asia reported the highest prevalence of ESBL Enterobacterales [100,111,112], CR Enterobacterales [60,67,100,132] and MRSA [26,28,35,54,60,67,69,87,95,96]. In contrast, the lowest prevalence of ESBL Enterobacterales, CR Enterobacterales and MRSA have been reported in Oceania [82,106,113,125], Europe [1,13,[18][19][20][21][22]34,83,103,104,[108][109][110]118] and South America [61]. With respect to MDR P. aeruginosa [64,142], A. baumannii [64,74,141], VRE [14,23,33,38,58,59,[64]…”

Section: Mdro Prevalencementioning

confidence: 99%

“…The ESBL Enterobacterales prevalence increased from 10.5% [14,18,22,23,25,31,33,39,57,75,76,82,85,89,99,101,102,104,106,107,111,112,116,119,[121][122][123][124][125]143] to 15.1% [1,16,[19][20][21]34,62,73,83,97,100,103,105,[108][109][110][113][114][115]117,118,120], but this ...…”

Section: Changes In Mdro Prevalence Over Timementioning

confidence: 99%

“…A Karnofsky index of ≤50% was the only risk factor that enhanced the institutionalized carrier rate in a prospective study conducted in France to identify and compare the residents of NH and LTCF (defined as exposure to the risk of carrying MDROs) with those living at home (defined as non-exposed) [99]. Some studies used a French index known as GIR to evaluate the level of dependency (varying from 1 to 6, with an index close to 1 indicating a high level of dependency) [46,118]. A GIR score of <3, corresponding to severe disabilities, was associated with MRSA carriage in a prevalence study performed in a 120-bed LTCF containing three units and belonging to a French teaching hospital [46].…”

Section: Dependence or Disabilitymentioning

confidence: 99%

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Prevalence and Risk Factors for Multidrug-Resistant Organisms Colonization in Long-Term Care Facilities Around the World: A Review

et al. 2021

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Elderly people confined to chronic care facilities face an increased risk of acquiring infections by multidrug-resistant organisms (MDROs). This review presents the current knowledge of the prevalence and risk factors for colonization by MDROs in long-term care facilities (LTCF), thereby providing a useful reference to establish objectives for implementing successful antimicrobial stewardship programs (ASPs). We searched in PubMed and Scopus for studies examining the prevalence of MDROs and/or risk factors for the acquisition of MDROs in LTCF. One hundred and thirty-four studies published from 1987 to 2020 were included. The prevalence of MDROs in LTCF varies between the different continents, where Asia reported the highest prevalence of extended-spectrum ß-lactamase (ESBL) Enterobacterales (71.6%), carbapenem resistant (CR) Enterobacterales (6.9%) and methicillin-resistant Staphylococcus aureus (MRSA) (25.6%) and North America the highest prevalence to MDR Pseudomonas aeruginosa (5.4%), MDR Acinetobacter baumannii (15.0%), vancomycin-resistant Enterococcus spp. (VRE) (4.0%), and Clostridioides difficile (26.1%). Furthermore, MDRO prevalence has experienced changes over time, with increases in MDR P. aeruginosa and extended spectrum ß-lactamase producing Enterobacterales observed starting in 2015 and decreases of CR Enterobacterales, MDR A. baumannii, VRE, MRSA and C. difficile. Several risk factors have been found, such as male sex, chronic wounds, the use of medical devices, and previous antibiotic use. The last of these aspects represents one of the most important modifiable factors for reducing colonization with MDROs through implementing ASPs in LTCF.

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Intestinal colonization with multidrug-resistant Enterobacterales: screening, epidemiology, clinical impact, and strategies to decolonize carriers

Campos-Madueno

Moradi

Eddoubaji

et al. 2023

Eur J Clin Microbiol Infect Dis

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The clinical impact of infections due to extended-spectrum β-lactamase (ESBL)- and/or carbapenemase-producing Enterobacterales (Ent) has reached dramatic levels worldwide. Infections due to these multidrug-resistant (MDR) pathogens—especially Escherichia coli and Klebsiella pneumoniae—may originate from a prior asymptomatic intestinal colonization that could also favor transmission to other subjects. It is therefore desirable that gut carriers are rapidly identified to try preventing both the occurrence of serious endogenous infections and potential transmission. Together with the infection prevention and control countermeasures, any strategy capable of effectively eradicating the MDR-Ent from the intestinal tract would be desirable. In this narrative review, we present a summary of the different aspects linked to the intestinal colonization due to MDR-Ent. In particular, culture- and molecular-based screening techniques to identify carriers, data on prevalence and risk factors in different populations, clinical impact, length of colonization, and contribution to transmission in various settings will be overviewed. We will also discuss the standard strategies (selective digestive decontamination, fecal microbiota transplant) and those still in development (bacteriophages, probiotics, microcins, and CRISPR-Cas-based) that might be used to decolonize MDR-Ent carriers.

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Prevalence, genetic diversity of and factors associated with ESBL-producing Enterobacterales carriage in residents of French nursing homes

Cited by 12 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

Prevalence and Risk Factors for Multidrug-Resistant Organisms Colonization in Long-Term Care Facilities Around the World: A Review

Intestinal colonization with multidrug-resistant Enterobacterales: screening, epidemiology, clinical impact, and strategies to decolonize carriers

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