The revolving door between hospital and community: extended-spectrum beta-lactamase-producing Escherichia coli in Dublin

Burke, Liam; Humphreys, Hilary; Fitzgerald-Hughes, Deirdre

doi:10.1016/j.jhin.2012.04.021

Cited by 35 publications

(26 citation statements)

References 25 publications

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“…Other epidemiologic and ecologic associations include ST131's predilection for elderly hosts and its high prevalence among longterm-care-facility (LTCF) residents in both the United States (20) and Europe (29)(30)(31)(32)(33)(34). Additionally, infections due to ESBL-positive ST131 have been associated with international travel (26,(35)(36)(37).…”

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confidence: 99%

A New Clone Sweeps Clean: the Enigmatic Emergence of Escherichia coli Sequence Type 131

Banerjee

Johnson

2014

Antimicrob Agents Chemother

219

215

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E scherichia coli sequence type 131 (ST131) is a recently emerged, extensively antimicrobial-resistant E. coli clonal group that has spread explosively throughout the world, driving the rapid increase in prevalence of antimicrobial resistance in E. coli (1-5). Such widespread expansion of a single clonal group is unprecedented in E. coli populations, although it has been seen in other antimicrobial-resistant pathogens such as methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus pneumoniae, and the NAP1 strain of Clostridium difficile (6, 7), and was foreshadowed by the notorious but less extensive expansion of E. coli "clonal group A" (8-10). Despite ST131 being recognized as a pandemic clonal group that threatens public health, ST131 has received comparatively less attention in the United States than have other antimicrobial-resistant pathogens. Here we review the epidemiology and molecular phylogeny of ST131, possible mechanisms for its ecological success, and implications of its widespread dissemination. EARLY STUDIES OF ST131 EPIDEMIOLOGY AND RESISTANCEST131, which is defined by the sequences of the 7 housekeeping genes that are commonly used for multilocus sequence typing (MLST) in E. coli according to the Achtman MLST scheme (http: //mlst.warwick.ac.uk/mlst/dbs/Ecoli), was first reported in 2008 by two research groups that were studying CTX-M-type extended-spectrum-beta-lactamase (ESBL)-producing E. coli (2, 11). By 2009, ST131 had been identified in 9 countries spanning 3 continents (3-5). ST131 belongs to (virulence-associated) E. coli phylogenetic group B2, and most isolates exhibit serotype O25b:H4, except for a small subset that are serotype O16:H5 (12) and rare variants with other serotypes (13). ST131 is associated with distinct combinations of extraintestinal virulence factors, compared with non-ST131 E. coli (4,(14)(15)(16)(17), and exhibits diverse pulsedfield gel electrophoresis (PFGE) profiles, several of which predominate globally (18).According to recent studies, the prevalence of ST131 among human clinical E. coli isolates varies by geographic region and host population, ranging overall from 12.5% (19) to nearly 30% (15, 20, 21) of E. coli clinical isolates. Like other extraintestinal pathogenic E. coli (ExPEC) strains, ST131 causes a variety of extraintestinal infections, including bacteremia, pneumonia, and urinary tract, intra-abdominal, and wound infections. Whether ST131 is associated with worse clinical outcomes than other E. coli strains is unclear, since some studies suggest that ST131 is more likely to cause persistent or recurrent urinary tract infections (20) or a higher frequency of sepsis (22), whereas others have found no difference in outcomes of infections with ST131 versus other E. coli strains (23, 24). In one study, patients infected with ST131 had persistent or recurrent symptoms in part because they received empirical therapy with fluoroquinolones (FQs), which are ineffective against most members of this clonal group (20).Regarding epidemiologi...

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confidence: 99%

A New Clone Sweeps Clean: the Enigmatic Emergence of Escherichia coli Sequence Type 131

Banerjee

Johnson

2014

Antimicrob Agents Chemother

219

215

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“…Although these findings seemingly contradict the largest body of work on this clone, which strongly delineates its community-associated nature, 5 a number of historical 8,9 and contemporary 10,11 studies have also demonstrated high rates of healthcare-associated and hospital-acquired ST131. However, none demonstrate these findings with the weight of the study by Banerjee et al 6 …”

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confidence: 89%

“…Two-way traffic of patients and resistant organisms between LTCFs and acute care facilities is almost invariable, with the term “revolving door” used by some to characterize this. 11 Heavy use of fluoroquinolones should likely shoulder some blame, although the true nature of their effect is not defined. Other than correlating individuals’ previous fluoroquinolone exposure to infection with fluoroquinolone-resistant ST131 clones, we have no information on the broader ecological impact of fluoroquinolone use on the spread of ST131.…”

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confidence: 99%

Who Is Leading This Dance? Understanding the Spread of Escherichia coli Sequence Type 131

Rogers

Doi

2013

Infect. Control Hosp. Epidemiol.

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“…609,[611][612][613][614][615][616][617][618][619] In the NHS, following major outbreaks of hospital-acquired (nosocomial) infection, 620 national targets for the reduction of MRSA bacteremias (blood infections) and C. difficile (gastrointestinal) infection are supported by enhanced mandatory surveillance. Oversight rests with the Health Protection Agency in England and Scotland, 592,597,621 and, in Wales, the WHAIP led by Public Health Wales.…”

Section: Reducing Health-care-associated Infectionmentioning

confidence: 99%

“…[655][656][657][658][659][660] IPAC teams, therefore, have a central role to play in active staff engagement, 661 support for peer-to-peer education, 662 and the monitoring of HCAIs to reduce the burden of avoidable harm to patients and its associated untoward costs. 581, The changing epidemiology of HCAIs 607,608,611,612,617, also places demands on medical microbiologists and clinical pharmacists specialising in antibiotic medicines management. 57,671 Collectively, their active stewardship of antibiotic prescribing is acknowledged to limit overprescribing 672 and improve adherence to guidelines.…”

Section: Reducing Health-care-associated Infectionmentioning

confidence: 99%

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

Herepath

Kitchener

Waring

2015

Health Serv Deliv Res

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BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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The revolving door between hospital and community: extended-spectrum beta-lactamase-producing Escherichia coli in Dublin

Cited by 35 publications

References 25 publications

A New Clone Sweeps Clean: the Enigmatic Emergence of Escherichia coli Sequence Type 131

A New Clone Sweeps Clean: the Enigmatic Emergence of Escherichia coli Sequence Type 131

Who Is Leading This Dance? Understanding the Spread of Escherichia coli Sequence Type 131

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

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