Household Transmission of Carbapenemase-producing Enterobacterales in Ontario, Canada.
carbapenem-resistant Enterobacteriaceae
disease transmission
epidemiology
public health
β-lactamases
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
06 12 2021
06 12 2021
Historique:
received:
21
06
2020
accepted:
27
08
2020
pubmed:
2
9
2020
medline:
15
3
2022
entrez:
2
9
2020
Statut:
ppublish
Résumé
Data on household transmission of carbapenemase-producing Enterobacterales (CPE) remain limited. We studied risk of CPE household co-colonization and transmission in Ontario, Canada. We enrolled CPE index cases (identified via population-based surveillance from January 2015 to October 2018) and their household contacts. At months 0, 3, 6, 9, and 12, participants provided rectal and groin swabs. Swabs were cultured for CPE until September 2017, when direct polymerase chain reaction (PCR; with culture of specimens if a carbapenemase gene was detected) replaced culture. CPE risk factor data were collected by interview and combined with isolate whole-genome sequencing to determine likelihood of household transmission. Risk factors for household contact colonization were explored using a multivariable logistic regression model with generalized estimating equations. Ninety-five households with 177 household contacts participated. Sixteen (9%) household contacts in 16 (17%) households were CPE-colonized. Household transmission was confirmed in 3/177 (2%) cases, probable in 2/177 (1%), possible in 9/177 (5%), and unlikely in 2/177 (1%). Household contacts were more likely to be colonized if they were the index case's spouse (odds ratio [OR], 6.17; 95% confidence interval [CI], 1.05-36.35), if their index case remained CPE-colonized at household enrollment (OR, 7.00; 95% CI, 1.92-25.49), or if they had at least 1 set of specimens processed after direct PCR was introduced (OR, 6.46; 95% CI, 1.52-27.40). Nine percent of household contacts were CPE-colonized; 3% were a result of household transmission. Hospitals may consider admission screening for patients known to have CPE-colonized household contacts.
Sections du résumé
BACKGROUND
Data on household transmission of carbapenemase-producing Enterobacterales (CPE) remain limited. We studied risk of CPE household co-colonization and transmission in Ontario, Canada.
METHODS
We enrolled CPE index cases (identified via population-based surveillance from January 2015 to October 2018) and their household contacts. At months 0, 3, 6, 9, and 12, participants provided rectal and groin swabs. Swabs were cultured for CPE until September 2017, when direct polymerase chain reaction (PCR; with culture of specimens if a carbapenemase gene was detected) replaced culture. CPE risk factor data were collected by interview and combined with isolate whole-genome sequencing to determine likelihood of household transmission. Risk factors for household contact colonization were explored using a multivariable logistic regression model with generalized estimating equations.
RESULTS
Ninety-five households with 177 household contacts participated. Sixteen (9%) household contacts in 16 (17%) households were CPE-colonized. Household transmission was confirmed in 3/177 (2%) cases, probable in 2/177 (1%), possible in 9/177 (5%), and unlikely in 2/177 (1%). Household contacts were more likely to be colonized if they were the index case's spouse (odds ratio [OR], 6.17; 95% confidence interval [CI], 1.05-36.35), if their index case remained CPE-colonized at household enrollment (OR, 7.00; 95% CI, 1.92-25.49), or if they had at least 1 set of specimens processed after direct PCR was introduced (OR, 6.46; 95% CI, 1.52-27.40).
CONCLUSIONS
Nine percent of household contacts were CPE-colonized; 3% were a result of household transmission. Hospitals may consider admission screening for patients known to have CPE-colonized household contacts.
Identifiants
pubmed: 32869855
pii: 5900006
doi: 10.1093/cid/ciaa1295
pmc: PMC8662791
doi:
Substances chimiques
Bacterial Proteins
0
beta-Lactamases
EC 3.5.2.6
carbapenemase
EC 3.5.2.6
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e4607-e4615Subventions
Organisme : CIHR
ID : 313039
Pays : Canada
Organisme : Government of Canada Vanier Canada Graduate Scholarship
Informations de copyright
© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
Références
J Antimicrob Chemother. 2013 May;68(5):1043-8
pubmed: 23288401
J Chronic Dis. 1987;40(5):373-83
pubmed: 3558716
Infect Control Hosp Epidemiol. 2020 Mar;41(3):286-294
pubmed: 31822301
Future Microbiol. 2016 Jul;11:857-64
pubmed: 27357522
J Antimicrob Chemother. 2010 May;65(5):859-65
pubmed: 20233775
Pediatr Crit Care Med. 2013 Feb;14(2):157-63
pubmed: 23254982
Clin Infect Dis. 2010 Feb 1;50(3):364-73
pubmed: 20041768
Infect Control Hosp Epidemiol. 2009 Oct;30(10):972-6
pubmed: 19712030
Nat Microbiol. 2019 Nov;4(11):1919-1929
pubmed: 31358985
Antimicrob Agents Chemother. 2015 Dec 28;60(3):1556-9
pubmed: 26711746
Clin Microbiol Infect. 2018 Dec;24(12):1241-1250
pubmed: 29654871
Med J Aust. 2014 Apr 21;200(7):386
pubmed: 24794661
Clin Infect Dis. 2012 Oct;55(7):967-75
pubmed: 22718774
Clin Microbiol Infect. 2013 Apr;19(4):E190-6
pubmed: 23331385
Emerg Infect Dis. 2011 Oct;17(10):1791-8
pubmed: 22000347
Clin Microbiol Infect. 2014 Feb;20(2):O117-23
pubmed: 23992130
Emerg Infect Dis. 2008 May;14(5):859-60
pubmed: 18439387
Lancet Infect Dis. 2011 May;11(5):355-62
pubmed: 21478057
Microb Genom. 2017 Jun 8;3(6):e000116
pubmed: 29026651
Microb Drug Resist. 2016 Mar;22(2):134-6
pubmed: 26954370
J Clin Microbiol. 2009 Oct;47(10):3261-5
pubmed: 19675211
Antimicrob Agents Chemother. 2016 Oct 21;60(11):6787-6794
pubmed: 27600052
Front Microbiol. 2018 Jun 05;9:1197
pubmed: 29951041
Clin Microbiol Infect. 2018 Sep;24(9):972-979
pubmed: 29331548
N Z Med J. 2017 Mar 24;130(1452):63-65
pubmed: 28337042
J Antimicrob Chemother. 2017 Jul 1;72(7):1922-1929
pubmed: 28369408
Clin Infect Dis. 2012 Oct;55(7):943-50
pubmed: 22752516
J Antimicrob Chemother. 2012 Sep;67(9):2090-100
pubmed: 22678728
Clin Microbiol Infect. 2011 Dec;17(12):E27-9
pubmed: 22011310
Clin Microbiol Infect. 2017 Jan;23(1):46.e1-46.e7
pubmed: 27596534
Euro Surveill. 2017 Oct;22(43):
pubmed: 29090680
J Infect Dis. 2020 May 11;221(11):1782-1794
pubmed: 31150539
J Clin Microbiol. 2012 Aug;50(8):2596-600
pubmed: 22622443
Clin Microbiol Infect. 2013 Jun;19(6):E278-80
pubmed: 23413937
Emerg Infect Dis. 2018 Sep;24(9):1674-1682
pubmed: 30124197
Eur J Clin Microbiol Infect Dis. 2017 Jun;36(6):1047-1055
pubmed: 28078557
Lancet Infect Dis. 2017 Jan;17(1):78-85
pubmed: 27751772
Infect Control Hosp Epidemiol. 2019 Sep;40(9):1006-1012
pubmed: 31244458
J Hosp Infect. 2010 Sep;76(1):70-3
pubmed: 20705205