Abstract
BackgroundApproximately 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.MethodsWe 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.ResultsAmong 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).ConclusionThese 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.
Highlights
11% of patients colonized with extended-spectrum beta-lactamase producing Entero‐ bacterales (ESBL-PE) are colonized with more than one Extended-spectrum beta-lactamase (ESBL)-producing species
Patients were assigned to the following groups (Fig. 1): Group 1: Patients colonized with multiple species of ESBL-PE
Group 2 included 22 cases with new ESBL-PE species identified during subsequent hospitalizations and group 3 consisted of 65 patients with the same ESBL-PE identified during multiple hospitalizations
Summary
11% of patients colonized with extended-spectrum beta-lactamase producing Entero‐ bacterales (ESBL-PE) are colonized with more than one ESBL-producing species. We investigated risk factors associated with colonization with multiple ESBL-PE species. Whether patients colonized or infected with multiple ESBL-PE species over time acquire a new ESBL-PE strain or whether their incident ESBL-PE species horizontally transferred plasmids harboring ESBL genes to other colonizing Enterobacterales species remains largely unknown. Understanding this fundamental question will provide insights on the evolving epidemic of ESBL-PE and will inform future infection prevention and antibiotic stewardship interventions to interrupt this pathway. We sought to evaluate patient-related characteristics and exposures associated with colonization with multiple rather than single ESBL-PE species and to identify associated ESBL-gene types to gain further epidemiological insights
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