Anna M Rohde1,2, Janine Zweigner1,2,3, Miriam Wiese-Posselt1,2, Frank Schwab1,2, Michael Behnke1,2, Axel Kola1,2, Wiebke Schröder1,4, Silke Peter1,5, Evelina Tacconelli1,4, Thorsten Wille1,6, Susanne Feihl1,7, Christiane Querbach1,7, Friedemann Gebhardt1,7, Hannah Gölz1,8, Christian Schneider1,8, Alexander Mischnik1,8, Maria J G T Vehreschild1,9,10, Harald Seifert1,6, Winfried V Kern1,11, Petra Gastmeier1,2, Axel Hamprecht1,6. 1. German Centre for Infection Research Association (DZIF), Braunschweig Germany. 2. Institute for Hygiene and Environmental Medicine, Charité - Universitätsmedizin Berlin, Germany, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health. 3. Department of Hospital Hygiene and Infection Control, University Hospital Cologne, Cologne, Germany. 4. Division of Infectious Diseases, Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany. 5. Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany. 6. Institute for Medical Microbiology, Immunology and Hygiene, University Hospital Cologne, Cologne, Germany. 7. Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany. 8. Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, Freiburg, Germany. 9. Department I of Internal Medicine, University Hospital of Cologne, Germany. 10. Department of Internal Medicine, Infectious Diseases, Goethe University, Frankfurt am Main, Germany. 11. Division of Infectious Diseases, Department of Medicine II, Medical Centre and Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Abstract
OBJECTIVES: To assess the admission prevalence of third-generation cephalosporin-resistant Enterobacterales (3GCREB) and to assess whether risk factors vary by β-lactamase genotype. METHODS: Adult patients were recruited within 72 h of admission to general wards of six university hospitals in 2014 and 2015. Rectal swabs were screened for 3GCREB and isolates were analysed phenotypically and genotypically. Patients were questioned on potential risk factors. Multivariable analyses were performed to identify risk factors for 3GCREB colonization and for specific β-lactamases. RESULTS: Of 8753 patients screened, 828 were 3GCREB positive (9.5%). Eight hundred and thirteen isolates were available for genotyping. CTX-M-15 was the most common ESBL (38.0%), followed by CTX-M-1 (22.5%), CTX-M-14 (8.7%), CTX-M-27 (7.5%) and SHV-ESBL (4.4%). AmpC was found in 11.9%. Interestingly, 18 Escherichia coli isolates were AmpC positive, 12 of which (67%) contained AmpC on a gene of plasmid origin [CMY (n = 10), DHA (n = 2)]. Risk factors for 3GCREB colonization varied by genotype. Recent antibiotic exposure and prior colonization by antibiotic-resistant bacteria were risk factors for all β-lactamases except CTX-M-14 and CTX-M-27. Travel outside Europe was a risk factor for CTX-M-15 and CTX-M-27 [adjusted OR (aOR) 3.49, 95% CI 2.88-4.24 and aOR 2.73, 95% CI 1.68-4.43]. A previous stay in a long-term care facility was associated with CTX-M-14 (aOR 3.01, 95% CI 1.98-4.59). A preceding hospital stay in Germany increased the risk of CTX-M-15 (aOR 1.27, 95% CI 1.14-1.41), while a prior hospital stay in other European countries increased the risk of SHV-ESBL colonization (aOR 3.85, 95% CI 1.67-8.92). CONCLUSIONS: The detection of different ESBL types is associated with specific risk factor sets that might represent distinct sources of colonization and ESBL-specific dissemination routes.
OBJECTIVES: To assess the admission prevalence of third-generation cephalosporin-resistant Enterobacterales (3GCREB) and to assess whether risk factors vary by β-lactamase genotype. METHODS: Adult patients were recruited within 72 h of admission to general wards of six university hospitals in 2014 and 2015. Rectal swabs were screened for 3GCREB and isolates were analysed phenotypically and genotypically. Patients were questioned on potential risk factors. Multivariable analyses were performed to identify risk factors for 3GCREB colonization and for specific β-lactamases. RESULTS: Of 8753 patients screened, 828 were 3GCREB positive (9.5%). Eight hundred and thirteen isolates were available for genotyping. CTX-M-15 was the most common ESBL (38.0%), followed by CTX-M-1 (22.5%), CTX-M-14 (8.7%), CTX-M-27 (7.5%) and SHV-ESBL (4.4%). AmpC was found in 11.9%. Interestingly, 18 Escherichia coli isolates were AmpC positive, 12 of which (67%) contained AmpC on a gene of plasmid origin [CMY (n = 10), DHA (n = 2)]. Risk factors for 3GCREB colonization varied by genotype. Recent antibiotic exposure and prior colonization by antibiotic-resistant bacteria were risk factors for all β-lactamases except CTX-M-14 and CTX-M-27. Travel outside Europe was a risk factor for CTX-M-15 and CTX-M-27 [adjusted OR (aOR) 3.49, 95% CI 2.88-4.24 and aOR 2.73, 95% CI 1.68-4.43]. A previous stay in a long-term care facility was associated with CTX-M-14 (aOR 3.01, 95% CI 1.98-4.59). A preceding hospital stay in Germany increased the risk of CTX-M-15 (aOR 1.27, 95% CI 1.14-1.41), while a prior hospital stay in other European countries increased the risk of SHV-ESBL colonization (aOR 3.85, 95% CI 1.67-8.92). CONCLUSIONS: The detection of different ESBL types is associated with specific risk factor sets that might represent distinct sources of colonization and ESBL-specific dissemination routes.
Authors: Enrique Rodríguez-Guerrero; Juan Carlos Callejas-Rodelas; José María Navarro-Marí; José Gutiérrez-Fernández Journal: Microorganisms Date: 2022-03-14