Prolonged carriage of ESBL-producing enterobacterales and potential cross-transmission among residents in geriatric long-term care facilities

Abstract

Previous studies indicated residents in geriatric long-term care facilities (LTCFs) had much higher prevalence of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) carriage than the general population. Most ESBL-E carriers are asymptomatic. The study tested the hypothesis that residents with ESBL-E carriage may accumulate inside geriatric LTCFs through potential cross-transmission after exposure to residents with prolonged ESBL-E carriage. 260 residents from four Japanese LTCFs underwent ESBL-E testing of fecal specimens and were divided into two cohorts: Cohort 1,75 patients with ≥ 2 months residence at study onset; Cohort 2, 185 patients with < 2 months residence at study onset or new admission during the study period. Three analyses were performed: (1) ESBL-E carriage statuses in Cohort 1 and Cohort 2; (2) changes in ESBL-E carriage statuses 3–12 months after the first testing and ≥ 12 months after the second testing; and (3) lengths of positive ESBL-E carriage statuses. Compared with the residents in Cohort 1, a significantly larger proportion of residents in Cohort 2 were positive for ESBL-E carriage (28.0% in Cohort 1 vs 40.0% in Cohort 2). In the subsequent testing results, 18.3% of residents who were negative in the first testing showed positive conversion to ESBL-E carriage in the second testing, while no patients who were negative in the second testing showed positive conversion in the third testing. The maximum length of ESBL-E carriage was 17 months. The findings indicated that some residents acquired ESBL-E through potential cross-transmission inside the LTCFs after short-term residence. However, no residents showed positive conversion after long-term residence, which indicates that residents with ESBL-E carriage may not accumulate inside LTCFs. Practical infection control and prevention measures could improve the ESBL-E prevalence in geriatric LTCFs.

Distribution of Extended-Spectrum β-Lactamase Genes and Antimicrobial Susceptibility among Residents in Geriatric Long-Term Care Facilities in Japan

“…All four g-LTCFs were anonymized in accordance with the ethics protocol of this study. Two related studies have been published using the same study settings and participants as the present study [ 50 , 51 ]. The Jichi Medical University Bioethics Committee for Medical Research approved this study and waived the requirement for informed consent from individual participants (Approval ID: 21–106).…”

“…These facilities typically aim to return patients to home-based care, although some residents may require long-term care for years. The latter provide daily life support, including end-of-life care [ 50 , 51 , 52 , 53 ]. This study included three geriatric health service facilities and one geriatric special nursing home.…”

“…We previously documented microbiology and ESBL-PE isolate procedures in a related study [ 51 ]. Small amounts (0.05–0.10 g) of freshly voided feces from the residents were obtained from paper diapers or papers for self-collection of stool samples (AS ONE Corporation, Osaka, Japan) using stool collection tubes with agar medium (FECES COLLECTING TUBE™; Eiken Chemical Co. Ltd., Tokyo, Japan).…”

Various types of extended spectrum β-lactamases: a literature review

“…However, it was later found in P. aeruginosa isolates from a patient from Thailand. [5][6][7][8][9][10][11] After that VEB-1 was reported in many gram-negative bacteria such as P. aeruginosa, K. pneumonia, A. baumannii, P. mirabilis, E. cloacae, C. freundii, and P. stuartii. ESBLs VEB-1 type which are widespread in Southeast Asia have reportedly been found in several countries including France, Belgium, England, Bulgaria, Iran, Kuwait, Algeria, China, Korea and India.…”

“…12 OXA types are grouped as class D in the Ambler classification and group 2d enzymes in the Bush-Jacoby-Medeiros functional classification. [3][4][5][6][7][8][9][10] The presence of OXA will make bacteria resistant to ceftazidime, but can be well inhibited by clavulanic acid. Not all OXA enzymes are ESBLs, some of them are plain oxacillinases but some have ESBL phenotypes and some are carbapenemases.…”