Risk factors for colonization with multiple species of extended-spectrum beta-lactamase producing Enterobacterales: a case-case-control study.
Co-colonization
ESBL
Extended-spectrum beta-lactamase producing Enterobacterales
Journal
Antimicrobial resistance and infection control
ISSN: 2047-2994
Titre abrégé: Antimicrob Resist Infect Control
Pays: England
ID NLM: 101585411
Informations de publication
Date de publication:
24 10 2021
24 10 2021
Historique:
received:
18
07
2021
accepted:
01
10
2021
entrez:
25
10
2021
pubmed:
26
10
2021
medline:
1
3
2022
Statut:
epublish
Résumé
Approximately 11% of patients colonized with extended-spectrum beta-lactamase producing Enterobacterales (ESBL-PE) are colonized with more than one ESBL-producing species. We investigated risk factors associated with colonization with multiple ESBL-PE species. We performed a case-case-control study at the University Hospital Basel, Switzerland, including hospitalized patients colonized with ESBL-PE between 01/2008 and 12/2018. Patients colonized with multiple species of ESBL-PE during the same hospitalization were assigned to group 1. Group 2 consisted of patients with ESBL-PE and a newly acquired ESBL-PE-species identified during subsequent hospitalization. Controls (i.e., group 3) were patients with only one species of ESBL-PE identified over multiple hospitalizations. Controls were frequency-matched 3:1 to group 2 cases according to time-at-risk (i.e., days between ESBL-PE detection during first and subsequent hospitalizations) to standardize the duration of colonization. ESBL was identified with phenotypic assay and the presence of ESBL genes was confirmed by whole genome sequencing. Among 1559 inpatients, 154 cases met eligibility criteria (67 in group 1, 22 in group 2, 65 in group 3). International travel within the previous 12 months (OR 12.57, 95% CI 3.48-45.45, p < 0.001) and antibiotic exposure within the previous 3 months (OR 2.96, 95% CI 1.37-6.41, p = 0.006) were independently associated with co-colonization with multiple ESBL-PE species. Admission from another acute-care facility was the only predictor of replacement of one ESBL-PE species with another during subsequent hospitalizations (OR 6.02, 95% CI 1.15-31.49, p = 0.003). These findings point to strain-related factors being the main drivers of co-colonization with different ESBL-PE and may support stratification of infection prevention and control measures according to ESBL-PE species/strains.
Sections du résumé
BACKGROUND
Approximately 11% of patients colonized with extended-spectrum beta-lactamase producing Enterobacterales (ESBL-PE) are colonized with more than one ESBL-producing species. We investigated risk factors associated with colonization with multiple ESBL-PE species.
METHODS
We performed a case-case-control study at the University Hospital Basel, Switzerland, including hospitalized patients colonized with ESBL-PE between 01/2008 and 12/2018. Patients colonized with multiple species of ESBL-PE during the same hospitalization were assigned to group 1. Group 2 consisted of patients with ESBL-PE and a newly acquired ESBL-PE-species identified during subsequent hospitalization. Controls (i.e., group 3) were patients with only one species of ESBL-PE identified over multiple hospitalizations. Controls were frequency-matched 3:1 to group 2 cases according to time-at-risk (i.e., days between ESBL-PE detection during first and subsequent hospitalizations) to standardize the duration of colonization. ESBL was identified with phenotypic assay and the presence of ESBL genes was confirmed by whole genome sequencing.
RESULTS
Among 1559 inpatients, 154 cases met eligibility criteria (67 in group 1, 22 in group 2, 65 in group 3). International travel within the previous 12 months (OR 12.57, 95% CI 3.48-45.45, p < 0.001) and antibiotic exposure within the previous 3 months (OR 2.96, 95% CI 1.37-6.41, p = 0.006) were independently associated with co-colonization with multiple ESBL-PE species. Admission from another acute-care facility was the only predictor of replacement of one ESBL-PE species with another during subsequent hospitalizations (OR 6.02, 95% CI 1.15-31.49, p = 0.003).
CONCLUSION
These findings point to strain-related factors being the main drivers of co-colonization with different ESBL-PE and may support stratification of infection prevention and control measures according to ESBL-PE species/strains.
Identifiants
pubmed: 34689820
doi: 10.1186/s13756-021-01018-2
pii: 10.1186/s13756-021-01018-2
pmc: PMC8543947
doi:
Substances chimiques
beta-Lactamases
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
153Informations de copyright
© 2021. The Author(s).
Références
J Antimicrob Chemother. 2017 Feb;72(2):582-588
pubmed: 27798205
J Antimicrob Chemother. 2017 Aug 1;72(8):2145-2155
pubmed: 28541467
J Microbiol Methods. 2015 Dec;119:203-5
pubmed: 26506282
Lancet. 2007 Oct 20;370(9596):1453-7
pubmed: 18064739
Euro Surveill. 2020 Jul;25(26):
pubmed: 32643598
Microb Drug Resist. 2011 Jun;17(2):267-73
pubmed: 21388296
Antimicrob Resist Infect Control. 2018 Jul 20;7:88
pubmed: 30038781
Clin Infect Dis. 2021 Mar 15;72(6):953-960
pubmed: 32149327
Lancet Infect Dis. 2017 Jan;17(1):78-85
pubmed: 27751772
Infect Control Hosp Epidemiol. 2019 Apr;40(4):400-407
pubmed: 30827286
J Antimicrob Chemother. 2016 Apr;71(4):1076-82
pubmed: 26755493
J Antimicrob Chemother. 2014 Jul;69(7):1972-80
pubmed: 24710025
J Biomed Inform. 2009 Apr;42(2):377-81
pubmed: 18929686
N Engl J Med. 2020 Apr 2;382(14):1309-1319
pubmed: 32242356
Int J Antimicrob Agents. 2016 Dec;48(6):647-654
pubmed: 27746102
Infect Control Hosp Epidemiol. 2018 Jun;39(6):660-667
pubmed: 29618394
Antimicrob Resist Infect Control. 2014 Sep 01;3:27
pubmed: 25237477
Bioinformatics. 2018 Sep 1;34(17):i884-i890
pubmed: 30423086
J Antimicrob Chemother. 2012 Nov;67(11):2640-4
pubmed: 22782487
Clin Microbiol Infect. 2010 Jul;16(7):934-44
pubmed: 19686277
Clin Microbiol Infect. 2019 Oct;25(10):1259-1265
pubmed: 30849431
Clin Infect Dis. 2021 Apr 26;72(8):1440-1443
pubmed: 32604410
J Travel Med. 2017 Apr 1;24(suppl_1):S29-S34
pubmed: 28520999
Lancet Infect Dis. 2008 Mar;8(3):159-66
pubmed: 18291338
J Hosp Infect. 2018 Mar;98(3):247-252
pubmed: 29222035
Crit Care Med. 2017 Apr;45(4):705-714
pubmed: 28157141
Front Microbiol. 2012 Apr 02;3:110
pubmed: 22485109
Microb Genom. 2017 Sep 4;3(10):e000131
pubmed: 29177089
PLoS One. 2016 Aug 30;11(8):e0161685
pubmed: 27574974
Int J Med Microbiol. 2015 Jan;305(1):148-56
pubmed: 25547265