Transmission dynamics of ESBL-producing Escherichia coli clones in rehabilitation wards at a tertiary care centre

A. Adler*, M. Gniadkowski, A. Baraniak, R. Izdebski, J. Fiett, W. Hryniewicz, S. Malhotra-Kumar, H. Goossens, C. Lammens, Y. Lerman, M. Kazma, T. Kotlovsky, Y. Carmeli

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Increasing resistance due to the production of ESBL in Escherichia coli (ESBL-E. coli) has become a major threat to public health. Our aims were to study the incidence of ESBL-E. coli acquisition during hospitalization and the transmission rates of different ESBL-E. coli clones. This was a prospective case-control study, conducted in two geriatric rehabilitation wards in Tel-Aviv. Serial rectal cultures were collected from admission till discharge. All patient-unique ESBL-E. coli isolates were subjected to molecular typing by PFGE, MLST and determination of ESBL genes. An acquisition of ESBL-E. coli was defined as traceable when a patient with the same ST, PFGE type and ESBL gene was hospitalized in the same ward in parallel to the acquisition case. ESBL-E. colis were recovered from 125 patients out of 492 enrolled: 52 were recovered upon admission, 59 acquired ESBL-E. coli during their stay, and there was undetermined status in 14 patients. A low Norton's score was associated with acquisition (O.R. 1.14 for each point, 95% C.I. 1.01-1.29, p<0.05). ESBL-E. coli infections (n=9) had occurred only in ESBL-E. coli carriers. The pandemic ST131 clone was the most common (48/125). The majority of the isolates (101/125) produced CTX-M-type ESBL. Of the 59 acquisition cases, 32 were traced to another patient. In-hospital dissemination was highest in the CTX-M-27-producing ST131 and the SHV-5-producing ST372 sub-clones (acquisition/admission ratios of 17/11 and 9/3, respectively), with almost all cases traced to other patients. In conclusion, most ESBL-E. coli acquisition cases were traceable to other patients. The transmission potential varied significantly between ESBL-E. coli clones.

Original languageEnglish
Pages (from-to)E497-E505
JournalClinical Microbiology and Infection
Issue number12
StatePublished - Dec 2012
Externally publishedYes


  • Clones
  • E. coli
  • ESBL
  • Rehabilitation wards
  • Transmission


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