Decline in AmpC β-lactamase-producing Escherichia coli in a Dutch teaching hospital (2013-2016).

Evert Den Drijver,Eefje J A Schrauwen,Stijn Oome,Ina Willemsen,Jan A J W Kluytmans,Marjolein F Q Kluytmans—Van Den Bergh,Joke Soer,Jaco J Verweij,Carlo Verhulst

doi:10.1371/journal.pone.0204864

Abstract

ObjectiveThe objective of this study is to determine the prevalence of rectal carriage of plasmid- and chromosome-encoded AmpC β-lactamase-producing Escherichia coli and Klebsiella spp. in patients in a Dutch teaching hospital between 2013 and 2016.MethodsBetween 2013 and 2016, hospital-wide yearly prevalence surveys were performed to determine the prevalence of AmpC β-lactamase-producing E. coli and Klebsiella spp. rectal carriage. Rectal swabs were taken and cultured using an enrichment broth and selective agar plates. All E. coli and Klebsiella spp. isolates were screened for production of AmpC β-lactamase using phenotypic confirmation tests and for the presence of plasmid-encoded AmpC (pAmpC) genes. E. coli isolates were screened for chromosome-encoded AmpC (cAmpC) promoter/attenuator alterations.ResultsFifty (2.4%) of 2,126 evaluable patients were identified as rectal carrier of AmpC β-lactamase-producing E. coli. No carriage of AmpC β-lactamase producing Klebsiella spp. was found. Nineteen (0.9%) patients harboured isolates with pAmpC genes and 30 (1,4%) patients harboured isolates with cAmpC promoter/attenuator alterations associated with AmpC β-lactamase overproduction. For one isolate, no pAmpC genes or cAmpC promotor/attenuator alterations could be identified. During the study period, a statistically significant decline in the prevalence of rectal carriage with E. coli with cAmpC promotor/attenuator alterations was found (p = 0.012). The prevalence of pAmpC remained stable over the years.ConclusionsThe prevalence of rectal carriage of AmpC-producing E. coli and Klebsiella spp. in patients in Dutch hospitals is low and a declining trend was observed for E. coli with cAmpC promotor/attenuator alterations.

Highlights

Antibiotic resistance caused by broad-spectrum β-lactamase production in Gram-negative bacteria is a well-known problem in clinical settings and in the community
The prevalence of rectal carriage of AmpC-producing E. coli and Klebsiella spp. in patients in Dutch hospitals is low and a declining trend was observed for E. coli with chromosome-encoded AmpC (cAmpC) promotor/attenuator alterations
Little is known on the carriage of either plasmid-encoded or chromosome-encoded AmpC Enterobacteriales in hospitalised patients in the North-Western European region and no studies have been performed over a multiple year period

Summary

Introduction

Antibiotic resistance caused by broad-spectrum β-lactamase production in Gram-negative bacteria is a well-known problem in clinical settings and in the community. Willemsen et al studied the epidemiology of ESBL rectal carriage between 2010 and 2014 in the same teaching hospital. In certain species (e.g. Escherichia coli and Shigella spp.), AmpC β-lactamase production is plasmid-encoded, but can be caused by chromosomal hyperproduction due to mutations within the promoter/attenuator region [4,9,10]. Little is known on the carriage of either plasmid-encoded (pAmpC) or chromosome-encoded AmpC (cAmpC) Enterobacteriales in hospitalised patients in the North-Western European region and no studies have been performed over a multiple year period. The present study describes the prevalence of rectal carriage with AmpC β-lactamase-producing E. coli and Klebsiella spp. in patients in Dutch hospitals during a four year period

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Results

Conclusion