TY - JOUR
T1 - Transmission dynamics of ESBL-producing Escherichia coli clones in rehabilitation wards at a tertiary care centre
AU - Adler, A.
AU - Gniadkowski, M.
AU - Baraniak, A.
AU - Izdebski, R.
AU - Fiett, J.
AU - Hryniewicz, W.
AU - Malhotra-Kumar, S.
AU - Goossens, H.
AU - Lammens, C.
AU - Lerman, Y.
AU - Kazma, M.
AU - Kotlovsky, T.
AU - Carmeli, Y.
N1 - Funding Information:
This work was part of the activities of the MOSAR integrated project (LSHP-CT-2007-037941) supported by the European Commission under the Life Science Health priority of the 6th Framework Programme (WP5 and WP2 Study Teams). MG, AB, RI, JF and WH were financed also by the MOSAR-complementary grant No. 934/6 PR UE/2009/7 from the Polish Ministry of Science and Higher Education.
Funding Information:
This study was a part of the project MOSAR (Mastering Hospital Antimicrobial Resistance and its Spread into the Community), a trans-disciplinary network funded by the European Commission, and devoted to combating and controlling resistance in bacteria. The project is focused on endemic and epidemic nosocomial pathogens in high-risk medical units, including ICUs, RWs and surgery wards in different European countries and Israel.
PY - 2012/12
Y1 - 2012/12
N2 - 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.
AB - 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.
KW - Clones
KW - E. coli
KW - ESBL
KW - Rehabilitation wards
KW - Transmission
UR - https://www.scopus.com/pages/publications/84869132751
U2 - 10.1111/j.1469-0691.2012.03999.x
DO - 10.1111/j.1469-0691.2012.03999.x
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C2 - 22963432
AN - SCOPUS:84869132751
SN - 1198-743X
VL - 18
SP - E497-E505
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 12
ER -