Carriage Of Extended-spectrum Beta-lactamase Research Articles

Extended spectrum beta-lactamase carriage among elderly residents of a long-term care facility in Beirut

Antimicrobial resistance is an emerging problem worldwide, endangering antimicrobials efficacy and resulting in high rates of morbidity and mortality. It is one of the major concerns that health care facilities are facing nowadays. Mainly, extended-spectrum beta-lactamases (ESBL)-producing Enterobacterales play a role in hydrolyzing β-lactams, specifically the third-generation cephalosporins. This study aimed to investigate the prevalence of fecal carriage and molecular characterization of ESBL-producing Enterobacterales among Lebanese elderly residents in a long-term care facility (Dar Al-Ajaza Al Islamia Hospital). Rectal culture swab specimens were collected from 132 patients at Dar Al Ajaza Al Islamia hospital between January 2019 till June 2020. The phenotype of ESBL producers was confirmed by a modified double disc synergy test and antibiotic susceptibility was determined using the Kirby-Bauer disk diffusion method. Genotypically, multiplex polymerase chain reaction was used to detect the ESBL genes. The main Enterobacterales strain observed was E coli (90.15%) followed by Klebsiella pneumoniae (4.54%) and Klebsiella oxytoca (3.80%). It has been found that the ESBL percentage rate has decreased when compared to a study conducted previously at the same hospital. Moreover, the predominant ESBL gene wasCTX-M (cefotaximase). This study is the first to demonstrate the improved current status of ESBL in one long-term care facility. In addition, the CTX-M is still the major type in ESBL-producing organisms.

1839. Social Determinants of Health in Extended Spectrum Beta-Lactamase Carriage in the Urine – The Influence of Race, Ethnicity and Sex in the Outpatient Setting

Abstract Background Urinary tract infections while common in the general population are frequently overdiagnosed in patients with asymptomatic bacteriuria. Overtreatment of asymptomatic bacteriuria leads to increasing levels of antibiotic resistance. Demographic factors including age and sex are associated with increased antibiotic resistance. There has been little to no prior research on the association of race or ethnicity with antibiotic resistance. Here we report the results of a retrospective analysis of urine cultures and the associations of race, ethnicity, age, and sex with the presence of extended spectrum beta-lactamases (ESBLs). Methods All urine cultures within the electronic medical record of Corewell Health East were screened for adult outpatients who live in the 3 counties within the main catchment area in southeast Michigan (Wayne, Macomb, and Oakland counties) with positive urine cultures for the year 2019. We identified 22,169 positive urine cultures, of which 1,571 were ESBLs. Demographics for each patient with an ESBL were analyzed including race, ethnicity, sex, age, and zip code. Zip codes were used to determine median annual household income using the 2020 United States Census records and 2019 Internal Revenue Service reports. Logistic regression estimated the association between race, ethnicity, sex, age, and income and presence of an ESBL in the urine. A stepwise regression was also performed to determine the strongest predictors of ESBL. Results Asian race (OR=3.06, 95% CI 2.41 – 3.89), Arabic/Middle Eastern ethnicity (OR= 2.48, 95% CI 1.99 – 3.09) and male sex (OR=2.02, 95% CI 1.76-2.31) were associated with ESBLs. Age showed an increase in the odds ratio of 1.014 for every year over the age of 18 (95% CI 1.012-1.017). No association was found with median annual household income and ESBL. Conclusion These findings show a clear relationship between race, ethnicity, sex, and age and ESBL which appears to be independent of economic status. This serves as proof of concept that social determinants of health are associated with antibiotic resistance. Future work should expand on these relationships in other types of infections which can then be utilized in predictive models of antibiotic resistance geared at improving empiric antibiotic selection in diverse populations. Disclosures Matthew Sims, MD, PhD, Astra-Zeneca: Investigator for company-sponsored studies|ContraFect: Investigator for company-sponsored studies|Crestone: Investigator for company-sponsored studies|Finch: Investigator for company-sponsored studies|Janssen: Investigator for company-sponsored studies|Leonard-Meron: Investigator for company-sponsored studies|Merck and Co: Investigator for company-sponsored studies|OpGen Inc: Advisor/Consultant|OpGen Inc: Investigator for company-sponsored studies|Pfizer: Investigator for company-sponsored studies|Prenosis: Advisor/Consultant|Prenosis: Investigator for company-sponsored studies|QIAGEN Sciences LLC: Investigator for company-sponsored studies|Roche: Investigator for company-sponsored studies|Seres Therapeutics: Investigator for company-sponsored studies

Carriage of Extended Spectrum Beta Lactamase-Producing Escherichia coli: Prevalence and Factors Associated with Fecal Colonization of Dogs from a Pet Clinic in Lower Saxony, Germany

Extended spectrum beta-lactamase (ESBL)-producing Escherichia coli are an emerging problem in veterinary and human medicine. Our study concentrated on the estimation of the prevalence and factors associated with the carriage of ESBL-producing E. coli in dogs who visited a veterinary clinic in northern Germany in 2017. For this reason, 1000 patients (healthy and sick dogs) were tested, resulting in 1000 samples originating from rectal swabs. Additional data were collected using a self-reported questionnaire that was completed by the dog owner. Factors associated with ESBL carriage were considered for further modeling if p < 0.05 using a two-sided Fisher test. Using a backward elimination procedure, the variables for the final multivariable logistic regression model were identified. In total, 8.9% of the dogs tested were positive for carriage of ESBL-producing E. coli. Seven factors were associated with the colonization of dogs with ESBL-E. coli within the multivariable model, namely husbandry system (p = 0.0019, OR = 3.00; 95% CI: 1.50-6.00), contact with puppies (p = 0.0044, OR = 2.43; 95% CI: 1.32-4.46), feeding of raw meat (p = 0.011, OR = 2.28; 95% CI: 1.21-4.31), food residues (p = 0.0151, OR = 2.31; 95% CI: 1.18-4.53) and food supplements (p = 0.0487, OR = 0.426; 95% CI: 0.18-0.96), and antibiotic treatments of dogs (p = 0.0005, OR = 3.030; 95% CI: 1.62-5.68) or owners (p = 0.041, OR = 2.74; 95% CI: 1.04-7.19) prior to the study. These factors refer to the animals themselves as well as to the owners and their habits or medical treatments. Although the causality and direction of transmission from owners to their dogs cannot be proven, the factor of antibiotic treatment of the owner is clearly associated with the dog's status.

Longitudinal Study of Dynamic Epidemiology of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli in Pigs and Humans Living and/or Working on Pig Farms.

Extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales have been increasingly isolated from pigs, highlighting their potential for transmission to humans living and/or working within pig farms. As longitudinal data on the prevalence and the molecular characteristics of such isolates from the high-risk farming population remain scarce, we performed a long-term study on 39 Dutch pig farms. Fecal samples from pigs, farmers, family members, and employees were collected during four sampling occasions with a 6-month period. The presence of ESBL-producing Enterobacterales and their molecular characteristics (ESBL gene, plasmid, and sequence types) were determined by standard methods. Data on personal and farm characteristics were collected using questionnaires. ESBL-producing Escherichia coli was present in pigs at least once for 18 of 39 farms and in 17 of 146 farmers, family members, and/or employees. Among these 417 E. coli isolates, blaCTX-M-1 was the most frequently observed ESBL gene in pigs (n = 261) and humans (n = 25). Despite the great variety in plasmid (sub)types and E. coli sequence types (STs), we observed genetic similarity between human- and pig-derived isolates in (i) ESBL gene, plasmid (sub)type, and ST, suggesting potential clonal transmission in seven farms, and (ii) only ESBL gene and plasmid (sub)type, highlighting the possibility of horizontal transfer in four farms. Five pig farmers carried ESBL producers repeatedly, of whom two carried an identical combination of gene, plasmid (sub)type, and ST over time. Human ESBL carriage was associated with both presence of ESBL producers in pigs and average number of hours working on the pig farm per week, while prolonged human carriage was observed only incidentally. IMPORTANCE Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli represents a public health hazard due to reduced therapeutic options for the treatment of infections. Although direct contact with pigs is considered a risk factor for human ESBL-producing E. coli carriage through occupational exposure, nationwide data regarding the occurrence of such isolates among pigs and humans living and/or working on farms remain scarce. Therefore, we determined (i) the longitudinal dynamics in prevalence and molecular characteristics of ESBL-producing E. coli in Dutch pig farmers and their pigs over time and (ii) the potential transmission events between these reservoirs based on genetic relatedness and epidemiological associations in longitudinal data. Our data suggesting the possibility of clonal and horizontal dissemination of ESBL-producing Escherichia coli between pigs and pig farmers can be used to inform targeted intervention strategies to decrease the within-farm human exposure to ESBL-producing E. coli.

Carriage Duration and Household Transmission of Enterobacterales Producing Extended-Spectrum Beta-Lactamase in the Community: A Systematic Review and Meta-Analysis.

An attributing factor to Enterobacterales producing extended-spectrum beta-lactamase (ESBL-E) community spread is human-to-human transmission. This systematic review and meta-analysis aimed to estimate the duration of ESBL-E carriage in the community and the rate of household transmission. Literature search was performed on PubMed, EMBASE, and Scopus. Dose-response meta-analysis was planned to model the proportion of ESBL-E carriers and household transmission over time. Twenty-six studies (n = 2,505 participants) were included. The median carriage duration was 2 months. Approximately 22% (95% confidence interval: 16-28) had persistent carriage after 12 months. Travelers had significantly shorter carriage (median 1-2 months) than discharged hospital patients (median 6 months) at all measured time points. There were insufficient data to robustly meta-analyze household transmission. Nonetheless, five longitudinal studies reported 18.4% to 35.2% of contacts acquired ESBL-E within 4 to 36 months from hospital discharge of index case. Transmission events from travelers to their contacts appeared lower. Travelers with travel-acquired ESBL-E had significantly faster decolonization rate than discharged patients, suggesting that travel-associated import of multidrug-resistant pathogen may have limited contribution to community transmission of ESBL-E. The substantial prevalence of persistent carriers warrant consideration for additional measures to mitigate exposure risk of ESBL-E from discharged patients in the community and from readmitting patients in the hospital.

Possible Acquisition of ESBL-mediated Antimicrobial Resistance by Farmers from Aquatic Reservoir used for Bathing and Cleaning of Water Buffalos (Bubalus bubalis) with Intestinal Carriage of ESBL Producing Escherichia coli

Little information is available on the risk of human subjects for acquisition of antimicrobial resistance (AMR) from aquatic environment other than those treated with antimicrobials for aquaculture. Carriage of extended-spectrum beta-lactamase (ESBL) and carbapenemase categories of AMR by enteric bacteria in livestock have been frequently reported. Dissemination of these categories of AMR to the environment thus poses a threat for their transmission to farmers engaged in livestock care posing a severe public health hazard. A study on the prevalence of ESBL- and carbapenemase-mediated AMR among Escherichia coli isolated from earth pond environment used for bathing and cleaning of buffalos (Bubalus bubalis) and from human subjects engaged in such activity revealed isolation rate of ESBL positivity to be higher in human subjects engaged in washing and bathing of buffalos (37.5%) compared to those without engagement in such activities (20.7%) with CTX-M type ESBL, a group of class A ESBL, as the predominant molecular type (97.4%). While no carbapenemase positivity could be detected among E. coli isolated from pond environment or buffalos, small percentage of carbapenemase could be detected among the E. coli isolated from human subjects although the risk was not higher than those not associated with bathing and cleaning of buffalos. Bathing and cleaning of buffalos could potentially facilitate transmission of ESBL resistance from livestock to human subjects in pond environment.

Fecal carriage of extended spectrum beta-lactamase producing Enterobacteriaceae among HIV infected children at the University of Gondar Comprehensive Specialized Hospital Gondar, Ethiopia

BackgroundHuman immunodeficiency virus (HIV) and extended spectrum beta lactamase (ESBL) producing Enterobacteriaceae infections are the major challenges in sub-Saharan Africa. Data on the carriage rate of ESBL producing Enterobacteriaceae among HIV infected children is lacking in Ethiopia. Hence this study was aimed to investigate fecal carriage of ESBL producing Enterobacteriaceae among HIV infected children at the University of Gondar comprehensive Specialized Hospital.MethodsA cross-sectional study was conducted among HIV infected children from January to April 2020. Stool specimens were collected from 161 study participants by convenient sampling and cultured on MacConkey agar. Biochemical identification, antimicrobial susceptibility testing including ESBL production were carried out. Data were analyzed by SPSS version-20 and P-value < 0.05 on multivariate logistic regression analysis was regarded as statistically significant.ResultsFrom a total of 161 study participants male to female ratio was 1:1.1. Moreover; 96.3% of participants were in HIV stage-I and 90.1% had at least a year highly active antiretroviral therapy exposure. A total of 186 Enterobacteriaceae, with E. coli 60% and K. pneumonia 16.13% predominance were isolated from 161 participants. Majority of isolates were most resistant to amoxicillin (95.1%) and sensitive to CHL (94.1%), CXT (91.4%) and CAZ (91.4%). There were 71(38.17%) multidrug resistant isolates, 13 of which were also ESBL producers. The overall ESBL carriage rate was 32/161 (19.9%). History of antibiotic use was the independent factor associated with ESBL carriage (AOR 3.23 (95% CI 1.054–9.88)) and P-value of 0.04.ConclusionESBL carriage rate of HIV infected children was considerable. Previous antibiotic use was the independent factor. Regular screening for antibiotic resistance on HIV patients before prescription and large-scale antibiotic resistance survey including healthy community may be important.

Faecal carriage of extended spectrum beta-lactamase (ESBL) and New Delhi metallo beta-lactamase(NDM) producing Escherichia coli between piglets and pig farmworkers

A cross-sectional study on five organized pig farms was conducted to assess the faecal carriage of ESBL and blaNDM carbapenemase-producing E. coli in piglets and pig farmworkers. Faecal samples from piglets (n = 155) and pig farmworkers (n = 21) were processed for isolation and characterization of E. coli. A total of 124 E. coli isolates from piglets and 21 E. coli isolates pig farmworkers were recovered and screening for ESBL production showed that 44.4 % (55/124) of the isolates from piglets and 42.9 % (9/21) of the isolates from farmworkers were ESBL positive. The ESBL positive isolates from piglets and farmworkers harbored blaCTX-M and also co-harbored other beta-lactams, sulphonamide, quinolone and tetracycline resistance genes. Diarrhoeic (50%, 49/98) and crossbred piglets (52.7%, 39/74) harbored a significantly higher number of ESBL producing isolates than non-diarrhoeic (23.1 %, 6/26) and purebred piglets (32%, 16/50) (p < 0.05). Piglets and pig farmworkers harbored nine and two carbapenem-resistant isolates, respectively. Interestingly, two isolates from piglets and one isolate from farmworkers harbored the blaNDM gene. The blaNDM positive E. coli isolated from piglets and farmworkers of the same farm revealed similar antibacterial resistance patterns, resistant genes, sequence (ST-167) and plasmid type (IncX3). In India, carbapenems are not used in food animal treatment, hence carbapenem resistant E. coli in piglets possibly originated from the human contact or common environment and is of public health importance.

Extended Spectrum Beta-Lactamases (ESBLs)-producing Escherichia coli and Klebsiella pneumoniae among asymptomatic Out-patients in a University Health Centre

Background: Asymptomatic carriage and spread of Extended-Spectrum Beta-Lactamase (ESBLs)-producing Enterobacteriaceae in the community are potential risk factors for transmission of infection. Objective: To determine the prevalence of ESBL resistant genes in Escherichia coli and Klebsiella pneumoniae isolated from asymptomatic out-patients. Methods: Using a questionnaire, demographic information, medical history, previous hospitalization and antibiotics used were obtained. Stool and urine samples were collected from 350 participants, cultured, and the susceptibility of the isolates to antibiotics and ESBL production were determined using the disk diffusion method. ESBL genes such as blaTEM, blaCTX, and blaSHV were identified using the Polymerase Chain Reaction. Results: Escherichia coli and Klebsiella pnuemoniae were identified from the stool samples (256; 69.9% and 89; 24.4% respectively) and urine samples (15; 4.1% and 6; 1.6% respectively). The isolates were susceptible to imipenem (330; 90.6%) and nitrofurantoin (307; 80.4%), most of the isolates were resistant to fluoroquinolones, cephalosporins, and aminoglycosides while all the isolates were resistant to ampicillin. The prevalence of ESBL was 29 (8.3%) and was observed in Escherichia coli (19; 7.0%) and Klebsiella pneumoniae (11; 12.0%), including a dual carriage. The ESBL carriers were resistant to the cephalosporins, fluoroquinolones and aminoglycosides. CTX-M (20; 66.7%), TEM (14; 46.7%), CTX-M and TEM genes co-existed in 9 (30.0%) while no SHV gene was detected in the isolates. Age, sex, prior hospitalization and antibiotics use did not predispose to ESBL carriage. Conclusion: Asymptomatic carriage of ESBL producing enterobacteria in the participants indicates that they can serve as a reservoir of the gene encoding for antibiotic resistance.

Phenotypic and Genotypic Characterization of Extended-Spectrum Beta-Lactamases Produced by Escherichia coli Colonizing Pregnant Women.

Introduction Infections caused by extended spectrum beta lactamase (ESBL) producing bacteria continue to be a challenge for choosing the appropriate therapy since they may exhibit coresistance to many other classes of antibiotics. The aim of the study was to screen pregnant women for ESBL producing bacteria in Beirut, Lebanon, to examine their phenotypic and genotypic characterization and to study the association between ESBL colonization with adverse neonatal outcomes. Method In this cross-sectional study, vaginal samples from 308 pregnant women at 35–37 weeks of gestation were studied during a one-year period. The samples were plated on MacConkey agar and selective MacConkey agar supplemented with ceftazidime. Phenotypic confirmation of ESBL production was performed by double-disc synergy test and all isolates were screened by PCR for the resistance genes blaSHV, blaTEM, and blaCTX-M. Clonal relatedness of Escherichia coli isolates was investigated by pulsed-field gel electrophoresis. Results In total, 59 women out of 308 (19.1%) were colonized by ESBL producing gram negative bacteria. Two babies born to mothers colonized with ESBL were diagnosed with sepsis. The susceptibility rates of isolates to other antibiotics were 39% to co-trimoxazole, 49.2% to ciprofloxacin, 91.5% to gentamicin, 18.6% to aztreonam and 35.6% to cefepime. Most of isolates were highly sensitive to meropenem and imipenem, with a susceptibility of 93.2%. PCR was performed on all E. coli isolates to detect the most common ESBL producing genes; blaCTX-M was the predominant gene (90.7%), followed by blaTEM (88.4%) and finally blaSHV (44.2%). PFGE analysis of 34 E. coli isolates revealed 22 distinct clusters showing more than 85% similarity. Conclusion In conclusion, this study showed that Lebanon has a high prevalence of ESBL carriage in pregnant women. Further studies that include a continuous screening of pregnant women and follow up of their newborn clinical status should be conducted to foresee the risk of transmission.

Screening for ESBL producing bacterial isolates of agricultural soil and profiling for multidrug resistance

Abstract Objectives construction of agricultural environmental soil antibiotic resistance profile of the culturable bacteria in Kalyani, India, followed by the screening of ESBL producers harboring blatem, blashv, and blactx-M. Methods 158 Multi-Drug Resistant (MDR) bacteria were isolated from 18 agricultural sampling points in Kalyani, West Bengal, India followed by their Antibiotic resistance profiling against 15 test antibiotics. They were then screened for the presence of three Extended Spectrum Beta-Lactamase (ESBL) genes, namely blatem, blactx-M and blashv by Double Disk Diffusion test and Polymerase Chain Reaction. The positive candidates were further identified using Amplified Ribosomal DNA Restriction Analysis followed by 16S rDNA sequencing. Results lowest resistance was observed against Vancomycin (0%) whereas the highest against the β lactam Ampicillin (97.5%). Very high resistance was observed against the 3rd generation cephalosporin Cefotaxime (90%). 16/158 bacterial isolates were positive for one or more of the three ESBL genes under investigation. 11 out of those 16 isolates (68.75%) harbored at least 2 genes and the rest 31.25% either had the blashv or the blatem gene. Phylogenetic analysis of the prevalent ESBL carrying organisms in the region demonstrated that the genes are being horizontally transferred across different bacterial orders and classes. Conclusion Significant antimicrobial resistance noted against 12 out of 15 antibiotics tested. Stenotrophomonas, Myroides, Pseudomonas, Enterobacter, and Serratia are found as culturable MDR bacteria carrying ESBL genes among the isolates. It is the first report of environmental ESBL carriage by Myroides isolated from India.

High prevalence of ESBL-Producing E. coli in private and shared latrines in an informal urban settlement in Dar es Salaam, Tanzania

BackgroundData about the burden of extended-spectrum beta-lactamase (ESBL)-producing microorganisms in Africa are limited. Our study aimed to estimate the prevalence of human faecal ESBL carriage in the community of an informal urban settlement in Dar es Salaam (Tanzania, East Africa) by using environmental contamination of household latrines with ESBL as a surrogate marker.MethodsWithin the context of a large survey in February 2014 assessing 636 randomly selected household latrines for faecal contamination by the detection of growth of E. coli and total faecal coliform bacteria, a randomly selected subset of the samples were screened for ESBL.ResultsSeventy latrines were screened for ESBL. An average of 11.4 persons (SD ±6.5) were sharing one latrine. Only three (4.3%) latrines had hand-washing facilities and 50 showed faeces on the floor. ESBL-producing Enterobacteriaceae were confirmed in 17 (24.3%) of the 70 latrine samples: 16 E. coli and 1 Klebsiella pneumoniae. Five ESBL E. coli strains were detected on door handles. The most prevalent ESBL type was CTX-M-1 group (76.5%). Pulsed-field gel electrophoresis typing of a subset of ESBL-producing E. coli isolates revealed both diverse singular types and a cluster of 3 identical isolates. There was no significant difference of the latrine and household characteristics between the group with ESBL (n = 17) and the group with non-ESBL E. coli (n = 53) (p > 0.05).ConclusionsAlmost a quarter of private and shared latrines in an informal urban settlement in Tanzania are contaminated with ESBL-producing microorganisms, suggesting a high prevalence of human ESBL faecal carriage in the community. Shared latrines may serve as a reservoir for transmission in urban community settings in Tanzania.

Fecal carriage of extended-spectrum beta-lactamase and ampc beta-lactamase-producing enterobacteriaceae in a turkish community.

Community-acquired infection caused by extended-spectrum beta-lactamase (ESBL)-producing microorganisms has an increasing frequency. The aim of this study was to determine the fecal carriage of ESBL and AmpC beta-lactamase-producing Enterobacteriaceae in community and to investigate cefotaxime-M (CTX-M) genes among ESBL isolates. A total of 1402 fecal specimens which were collected from outpatients included in the study. ESBL screening, ESBL production, and AmpC beta-lactamase detection were performed. Matrix-assisted laser desorption ionization-time-of-flight (MALDI-TOF) was used for identification of species. Antibiotic susceptibilities of the isolates were detected by disk diffusion method. CTX-M beta-lactamase genes were investigated by polymerase chain reaction. During the study period, a total of 1402 fecal samples were analysed with ESBL screening test and 490 Enterobacteriaceae strains isolated from these samples (Escherichia coli [n = 461, 94.1%], Klebsiella pneumoniae [n = 25, 5.1%], and Enterobacter cloacae [n = 4, 0.8%]). Fecal carriage of ESBL-producing Enterobacteriaceae in the community was 34.3%. AmpC beta-lactamases were detected in 26 (5.3%), and the frequency of CTX-M was found as 96.9%. The resistance rates of the E. coli strains to fluoroquinolones, trimethoprim-sulfamethoxazole, and carbapenems were 31.2%, 33.3%, and 0%, respectively. The relative high prevalence of fecal carriage of ESBL-producing bacteria in community warrants further study in this field including developing policies about antimicrobial use and close monitoring of resistance patterns.

Longitudinal genomic surveillance of multidrug-resistant Escherichia coli carriage in a long-term care facility in the United Kingdom

BackgroundResidents of long-term care facilities (LTCF) may have high carriage rates of multidrug-resistant pathogens, but are not currently included in surveillance programmes for antimicrobial resistance or healthcare-associated infections. Here, we describe the value derived from a longitudinal epidemiological and genomic surveillance study of drug-resistant Escherichia coli in a LTCF in the United Kingdom (UK).MethodsForty-five of 90 (50%) residents were recruited and followed for six months in 2014. Participants were screened weekly for carriage of extended-spectrum beta-lactamase (ESBL) producing E. coli. Participants positive for ESBL E. coli were also screened for ESBL-negative E. coli. Phenotypic antibiotic susceptibility of E. coli was determined using the Vitek2 instrument and isolates were sequenced on an Illumina HiSeq2000 instrument. Information was collected on episodes of clinical infection and antibiotic consumption.ResultsSeventeen of 45 participants (38%) carried ESBL E. coli. Twenty-three of the 45 participants (51%) had 63 documented episodes of clinical infection treated with antibiotics. Treatment with antibiotics was associated with higher risk of carrying ESBL E. coli. ESBL E. coli was mainly sequence type (ST)131 (16/17, 94%). Non-ESBL E. coli from these 17 cases was more genetically diverse, but ST131 was found in eight (47%) cases. Whole-genome analysis of 297 ST131 E. coli from the 17 cases demonstrated highly related strains from six participants, indicating acquisition from a common source or person-to-person transmission. Five participants carried highly related strains of both ESBL-positive and ESBL-negative ST131. Genome-based comparison of ST131 isolates from the LTCF study participants with ST131 associated with bloodstream infection at a nearby acute hospital and in hospitals across England revealed sharing of highly related lineages between the LTCF and a local hospital.ConclusionsThis study demonstrates the power of genomic surveillance to detect multidrug-resistant pathogens and confirm their connectivity within a healthcare network.

Air exposure as a possible route for ESBL in pig farmers

Livestock can carry extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, with blaCTX-M-1 being most prevalent. ESBL carriage in farmers is associated with ESBL carriage in animals, with direct animal-human contact considered as the dominant route of transmission. However, inhalation of stable air might represent another route of transmission. We, therefore, quantified presence of blaCTX-M group 1 genes (CTX-M-gr1) in dust and the association with CTX-M-gr1 carriage in pig farmers, family members and employees. We included 131 people living and/or working on 32 conventional Dutch pig production farms (farmers, family members and employees) during two sampling moments over a 12-month interval. Human stool samples, rectal swabs from 60 pigs per farm, and 2–5 dust samples collected using an electrostatic dust collector (EDC) (as a proxy for presence of viable CTX-M-gr1 carrying bacteria in air) were obtained per farm. Presence of ESBL-producing Escherichia Coli (E. coli) in stool samples and rectal swabs was determined by selective plating and CTX-M-gr1 was identified by PCR. Dust samples were analyzed directly by PCR for presence of CTX-M-gr1. Questionnaires were used to collect information on nature, intensity and duration of animal contact. Overall human prevalence of CTX-M-gr1 carriage was 3.6%. CTX-M-gr1 was detected in dust on 26% of the farms and in pigs on 35% of the farms, on at least one sampling moment. Human CTX-M-gr1 carriage and presence of CTX-M-gr1 in dust were associated univariately (OR=12.4, 95% CI=2.7–57.1). In multivariate analysis human CTX-M-gr1 carriage was associated with the number of working hours per week (OR=1.03, 95% CI=1.00–1.06), presence of CTX-M-gr1 carrying pigs on the farm (OR=7.4, 95% CI=1.1–49.7) and presence of CTX-M-gr1 in dust (OR=3.5, 95% CI=0.6–20.9). These results leave open the possibility of airborne CTX-M-gr1 transmission from animals to humans next to direct contact.

Faecal carriage of ESBL and plasmid-mediated AmpC β-lactamase genes in &lt;i&gt;Klebsiella&lt;/i&gt; spp. and &lt;i&gt;Shigella&lt;/i&gt; spp. isolated from inpatient and outpatient carriers in Tabriz, Iran.

The growing incidence of community acquired infection due to Extended -Spectrum Beta- Lactamase (ESBL) - and plasmid-mediated AmpC β-lactamase prducing bacteria represent a great concern because there are few therapeutic choices. This study was aimed to determine the prevalence of faecal carriage of ESBL producing Klebsiella spp. and Shigella spp. among inpatient and outpatient and their phenotype-genotype resistance correlation that conveyed ESBL with or without AmpC genes at a university hospital in Tabriz, Iran. During March to May 2015, 200 faecal samples from hospitalized and non -hospitalized patients without gas trointestinal illness and diarrhea were cultured on MacConkey agar plate supplemented with 2 μg/mL of cefotaxime.

Air exposure as a possible route for ESBL in pig farmers

Introduction: Livestock can carry extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, with CTX-M-1 ESBLs as the most important enzyme representatives. ESBL carriage in farmers is associated with ESBL carriage in animals which is frequently thought to originate from direct animal-human contact. However, inhalation of stable air might represent a second route of transmission. We investigated the presence of ESBL genes belonging to blaCTX-M group 1 (CTX-M-1gr) in dust and the association with CTX-M-1gr carriage in pig farmers, family members and employees. Methods: 146 people living and/or working on 34 conventional Dutch pig production farms (farmers, family members and employees) were enrolled. Human stool samples, rectal swabs from 60 pigs per farm, and 2-5 passively sampled dust samples (as a proxy for presence of viable CTX-M-1gr carrying bacteria in air) per farm were obtained during two sampling moments with a 12-month interval. Presence of ESBL-producing E. coli in stool samples and rectal swabs was determined by selective plating and CTX-M-1gr was identified by PCR. Dust samples were analyzed directly by PCR for presence of CTX-M-1gr. Questionnaires were used to collect information on intensity and duration of animal contact. Results: Overall human prevalence of CTX-M-1gr carriage was 3.6% and CTX-M-1gr carrying pigs were present on 30% of the farms. CTX-M-1gr was detected in dust on 21% of the farms. Human CTX-M-1gr carriage and presence of CTX-M-1gr in dust were associated univariately (OR=11.9, 95% CI=2.6-55.4). In multivariate analysis human CTX-M-1gr carriage was associated with working hours per week (OR=1.03, 95% CI=1.00-1.06), presence of CTX-M-1gr carrying pigs on the farm (OR=7.3, 95% CI=1.1-48.8) and presence of CTX-M-1gr in dust (OR=3.5; 95% CI=0.6-20.7). Conclusions: Transmission of CTX-M-1gr from animals to human might be possible through air, pending verification of the presence of viable ESBL producers in air.

Comparison of rates of fecal colonization with extended-spectrum beta-lactamase-producing enterobacteria among patients in different wards, outpatients and medical students.

Because asymptomatic carriage of extended-spectrum beta-lactamase (ESBL) producers is a risk factor for infection, data on colonization dynamics are important when planning infection control. This study investigated fecal colonization with ESBL producers among inpatients, outpatients and medical students and compares the characteristics of ESBL producers among these groups. Carriage rates were investigated in 5581 fecal samples; 4343 from inpatients (330, 1397, 619 and 1864 from adult ICUs [intensive care units], adult non-ICUs, pediatric ICUs and pediatric non-ICUs, respectively), 814 from outpatients and 424 from screening of medical students. ESBL producers were characterized by co-resistance, integrons carried, and aminoglycoside resistance and ESBL genes. Dynamic regression models were built to identify relationships between combinations of time series of monthly antibiotic consumption, prevalence of carriers and infected subjects. Inpatients, ICU patients and adults showed higher prevalence than outpatients, non-ICU patients or children (7.4%, 9.3% and 12.0% vs. 3.1%, 6.1% and 4.1%, respectively). Klebsiella pneumoniae was more frequent in ICU patients; dominance of CTX-M-15 producers was more marked in adult than in pediatric inpatients. ESBL carriage was shown to be a consequence of infection in adults in the time-series analysis; antibiotic consumption had little effect. The epidemiology of colonization with ESBL producers differed between pediatric ICU, adult ICU and adult non-ICU patients. In adults, carriage of ESBL producers seems to be the consequence of infection, especially in ICU patients; the main source of colonization is nosocomial acquisition. In contrast, children are less likely to acquire colonizer strains in hospitals; importation of ESBL producers by colonized children seems to be significant.

Multiple ESBL-Producing Escherichia coli Sequence Types Carrying Quinolone and Aminoglycoside Resistance Genes Circulating in Companion and Domestic Farm Animals in Mwanza, Tanzania, Harbor Commonly Occurring Plasmids.

The increased presence of extended-spectrum beta-lactamase (ESBL)-producing bacteria in humans, animals, and their surrounding environments is of global concern. Currently there is limited information on ESBL presence in rural farming communities worldwide. We performed a cross-sectional study in Mwanza, Tanzania, involving 600 companion and domestic farm animals between August/September 2014. Rectal swab/cloaca specimens were processed to identify ESBL-producing Enterobacteriaceae. We detected 130 (21.7%) animals carrying ESBL-producing bacteria, the highest carriage being among dogs and pigs [39.2% (51/130) and 33.1% (43/130), respectively]. The majority of isolates were Escherichia coli [93.3% (125/134)] and exotic breed type [OR (95%CI) = 2.372 (1.460–3.854), p-value < 0.001] was found to be a predictor of ESBL carriage among animals. Whole-genome sequences of 25 ESBL-producing E. coli were analyzed for phylogenetic relationships using multi-locus sequence typing (MLST) and core genome comparisons. Fourteen different sequence types were detected of which ST617 (7/25), ST2852 (3/25), ST1303 (3/25) were the most abundant. All isolates harbored the blaCTX-M-15 allele, 22/25 carried strA and strB, 12/25 aac(6′)-lb-cr, and 11/25 qnrS1. Antibiotic resistance was associated with IncF, IncY, as well as non-typable plasmids. Eleven isolates carried pPGRT46-related plasmids, previously reported from isolates in Nigeria. Five isolates had plasmids exhibiting 85–99% homology to pCA28, previously detected in isolates from the US. Our findings indicate a pan-species distribution of ESBL-producing E. coli clonal groups in farming communities and provide evidence for plasmids harboring antibiotic resistances of regional and international impact.

High Prevalence of Escherichia coli-Producing CTX-M-15 Extended-Spectrum Beta-Lactamases in Poultry and Human Clinical Isolates in Romania.

Use of antibiotics in food animals may contribute to development and spread of resistant organisms, particularly so in some countries. The aim of this study was two-fold; first, to establish the prevalence of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli in chicken production in a region within Romania. Second, to study the relatedness of ESBL-producing E. coli isolates recovered from broilers, abattoir workers where the chickens were slaughtered and from the human clinical specimens from two regional hospitals. The results indicated a very high (69%) rate of carriage of ESBL and AmpC-producing E. coli in chickens with 36% CTX-M producers. Sequencing showed that chickens in Romania have the highest worldwide prevalence (53%) of blaCTX-M-15 reported in poultry E. coli isolates. The majority (53%) of the extended-spectrum cephalosporin-resistant E. coli carried plasmid-mediated blaampC genes, mostly blaCMY-2 type, one of the highest prevalences reported in Europe. The predominant CTX-M type found in the human clinical E. coli isolates was blaCTX-M-15 and most isolates coharbored blaOXA-1, blaTEM, and aac(6')-ib-cr. The majority (60%) of the human clinical isolates belonged to the pandemic virulent clone B2-ST131. The clonal relationship between broiler and the human CTX-M-producing E. coli isolates was assessed by macrorestriction pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST), which indicated strain diversity with no common STs found between human and poultry isolates. Moreover, IncI1 was the most prevalent replicon found in broiler ESBL-producing E. coli isolates and also in transconjugants, indicating that plasmids and not clonal spread may play a role in the transfer of blaCTX-M genes. This study identifies a high prevalence of ESBL-producing E. coli from broiler chickens in Romania with a high occurrence incidence of blaCTX-M-15, which reflects the main ESBL type found in human E. coli infections in this country.