Abstract
We have performed a prospective cohort study to investigate the duration of and risk factors for prolonged fecal carriage of ESBL-producing Escherichia coli or Klebsiella pneumoniae in patients with community acquired urinary tract infection caused by these bacteria. From 2009 to 2011, 101 Norwegian patients were recruited. Stool swabs and questionnaires were collected every three months for one year and at the end of the study in 2012. Information on antibiotic prescriptions was collected from the Norwegian Prescription Database. Stool samples were cultured directly on ChromID ESBL agar as well as in an enrichment broth, and culture positive isolates were examined by blaCTX-M multiplex PCR. Isolates without blaCTX-M were investigated for alternative ESBL-determinants with a commercial microarray system. Time to fecal clearance of ESBL producing Enterobacteriaceae was also analysed using Kaplan-Meier estimates. Uni- and multivariate logistic regression was used to compare groups according to previously described risk factors. The ESBL point prevalence of fecal carriage were 61% at 4 months, 56% at 7 months, 48% at 10 months, 39% at 13 months, 19% after two years, and 15% after three years or more. We found no correlation between duration of carriage, comorbidity, antibiotic use or travel to ESBL high-prevalence countries. Prolonged carriage was associated with E. coli isolates of phylogroup B2 or D. Importantly, comparative MLST and MLVA analyses of individual paired urine and fecal E. coli isolates revealed that ESBL production commonly occurred in diverse strains within the same host. When investigating cross-transmission of ESBL producing bacteria in health care institutions, this notion should be taken into account.
Highlights
Extended spectrum β-lactamase producing Enterobacteriaceae (ESBL-E) are an important cause of nosocomial and community acquired infections [1,2]
In this prospective cohort study of the same patients, we examined the duration of fecal carriage of ESBL-E, potential risk factors for prolonged carriage and the clonal relatedness between paired ESBL-producing E. coli urinary and fecal strains
We observed an overall ESBL-E fecal clearance rate of 56% one year after a UTI caused by an ESBL-producing E. coli or K. pneumoniae
Summary
Extended spectrum β-lactamase producing Enterobacteriaceae (ESBL-E) are an important cause of nosocomial and community acquired infections [1,2]. The spread of ESBL-E is facilitated by their reservoir in the gut of healthy humans and animals, and in water [3]. Certain clones, such as the epidemic Escherichia coli strain CTX-M 15 ST131, have successfully disseminated internationally [4]. There are few studies regarding the time course of carriage of ESBL-E in the intestine and the factors that may influence duration of carriage [12,15,16,17,18]. Knowledge about carriage duration is important for implementation of adequate infection control measures, and essential in the construction of mathematical models in our understanding of the epidemiology of ESBL-E dissemination
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