Abstract
Objectives: To reveal the prevalence and epidemiology of extended-spectrum β-lactamase (ESBL)- and/or plasmid AmpC (pAmpC)- and carbapenemase (CP) producing Enterobacteriaceae and vancomycin-resistant enterococci (VRE) across the Northern Dutch–German border region.Methods: A point-prevalence study on ESBL/pAmpC/CP producing Enterobacteriaceae and VRE was carried out in hospitalized patients in the Northern Netherlands (n = 445, 2012–2013) and Germany (n = 242, 2012). Healthy individuals from the Dutch community (n = 400, 2010–2012) were also screened. In addition, a genome-wide gene-by-gene approach was applied to study the epidemiology of ESBL-Escherichia coli and VRE.Results: A total of 34 isolates from 27 patients (6.1%) admitted to Dutch hospitals were ESBL/pAmpC positive and 29 ESBL-E. coli, three pAmpC-E. coli, one ESBL-Enterobacter cloacae, and one pAmpC-Proteus mirabilis were found. In the German hospital, 18 isolates (16 E. coli and 2 Klebsiella pneumoniae) from 17 patients (7.7%) were ESBL positive. In isolates from the hospitalized patients CTX-M-15 was the most frequently detected ESBL-gene. In the Dutch community, 11 individuals (2.75%) were ESBL/pAmpC positive: 10 ESBL-E. coli (CTX-M-1 being the most prevalent gene) and one pAmpC E. coli. Six Dutch (1.3%) and four German (3.9%) hospitalized patients were colonized with VRE. Genetic relatedness by core genome multi-locus sequence typing (cgMLST) was found between two ESBL-E. coli isolates from Dutch and German cross-border hospitals and between VRE isolates from different hospitals within the same region.Conclusion: The prevalence of ESBL/pAmpC-Enterobacteriaceae was similar in hospitalized patients across the Dutch–German border region, whereas VRE prevalence was slightly higher on the German side. The overall prevalence of the studied pathogens was lower in the community than in hospitals in the Northern Netherlands. Cross-border transmission of ESBL-E. coli and VRE seems unlikely based on cgMLST analysis, however continuous monitoring is necessary to control their spread and stay informed about their epidemiology.
Highlights
International travel and patient care are risk factors for dissemination of bacteria including multidrug-resistant microorganisms (MDRO), such as extended-spectrum β-lactamase (ESBL) and carbapenemase (CP)-producing Enterobacteriaceae (Woerther et al, 2013; Muller et al, 2015), and vancomycin-resistant enterococci (VRE)
The results of this study suggest that ESBL/plasmid-mediated AmpC (pAmpC)-E. coli circulate in the hospital and the community, a higher prevalence of ESBL/pAmpCE. coli was observed in hospitals compared to the community in the Northern Netherlands
Hospitals in the Northern Dutch–German region showed a similar prevalence of ESBL/ pAmpC-Enterobacteriaceae
Summary
International travel and patient care are risk factors for dissemination of bacteria including multidrug-resistant microorganisms (MDRO), such as extended-spectrum β-lactamase (ESBL) and carbapenemase (CP)-producing Enterobacteriaceae (Woerther et al, 2013; Muller et al, 2015), and vancomycin-resistant enterococci (VRE). The prevalence of the latter has increased in the last years due to successful polyclonal subpopulations of hospital-associated (HA) Enterococcus faecium [previously designated clonal complex (CC) CC17] and which are associated with amoxicillin resistance (ARE) (Arias and Murray, 2012). There is no cgMLST scheme nor threshold publicly approved yet for Escherichia coli, there are several tools available that allow to define an ad hoc cgMLST
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
