Abstract
The extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli clone ST131 (ESBL-ST131) has spread in healthcare settings worldwide. The reasons for its successful spread are unknown, but might include more effective transmission and/or longer persistence. We evaluated the colonisation dynamics of ESBL-producing E. coli (ESBL-EC), including ESBL-ST131, in a long-term care facility (LTCF) with an unusually high prevalence of rectal ESBL-EC colonisation. During a 14-month period, rectal or faecal samples were obtained from 296 residents during six repetitive prevalence surveys, using ESBL-selective culture. Transmission rates, reproduction numbers, and durations of colonisation were compared for ESBL-ST131 vs other ESBL-EC. Furthermore, the likely time required for ESBL-ST131 to disappear from the LTCF was estimated. Over time, the endemic level of ESBL-ST131 remained elevated whereas other ESBL-EC returned to low-level prevalence, despite comparable transmission rates. Survival analysis showed a half-life of 13 months for ESBL-ST131 carriage, vs two to three months for other ESBL-EC (p < 0.001). Per-admission reproduction numbers were 0.66 for ESBL-ST131 vs 0.56 for other ESBL-EC, predicting a mean time of three to four years for ESBL-ST131 to disappear from the LTCF under current conditions. Transmission rates were comparable for ESBL-ST131 vs other ESBL-EC. Prolonged rectal carriage explained the persistence of ESBL-ST131 in the LTCF.
Highlights
The prevalence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae is increasing rapidly worldwide [1,2]
We evaluated the dynamics of colonisation with ESBLproducing Enterobacteriaceae among residents of a long-term care facility (LTCF) in the Netherlands over 14 months, from March 2013 to April 2014
In the studied LTCF a high endemic level of ESBL-ST131 colonisation persisted in spite of measures taken, while colonisation with other ESBL-producing E. coli (ESBL-EC) returned to a more normal level over time
Summary
The prevalence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae is increasing rapidly worldwide [1,2] Infections with these and other resistant bacteria are associated with higher morbidity, mortality, and healthcare costs [3,4]. Residents of LTCFs are mainly frail, elderly people, with underlying diseases who often have medical devices and need regular medical care Among these residents, a low functional status and higher medical and nursing dependence are associated with a greater risk of ESBL carriage [9]. The amount of interaction between LTCF residents is higher than between hospitalised patients This may be an important factor for transmission since the risk of transmission of ESBL-producing Enterobacteriaceae is greater among household contacts than among hospital inpatients [10].
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