Household acquisition and transmission of extended-spectrum β-lactamase (ESBL) -producing Enterobacteriaceae after hospital discharge of ESBL-positive index patients
Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved..
OBJECTIVES: This study aimed to determine rates and risk factors of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) acquisition and transmission within households after hospital discharge of an ESBL-PE-positive index patient.
METHODS: Two-year prospective cohort study in five European cities. Patients colonized with ESBL-producing Escherichia coli (ESBL-Ec) or Klebsiella pneumoniae (ESBL-Kp), and their household contacts were followed up for 4 months after hospital discharge of the index case. At each follow up, participants provided a faecal sample and personal information. ESBL-PE whole-genome sequences were compared using pairwise single nucleotide polymorphism-based analysis.
RESULTS: We enrolled 71 index patients carrying ESBL-Ec (n = 45), ESBL-Kp (n = 20) or both (n = 6), and 102 household contacts. The incidence of any ESBL-PE acquisition among household members initially free of ESBL-PE was 1.9/100 participant-weeks at risk. Nineteen clonally related household transmissions occurred (case to contact: 13; contact to case: 6), with an overall rate of 1.18 transmissions/100 participant-weeks at risk. Most of the acquisition and transmission events occurred within the first 2 months after discharge. The rate of ESBL-Kp household transmission (1.16/100 participant-weeks) was higher than of ESBL-Ec (0.93/100 participant-weeks), whereas more acquisitions were noted for ESBL-Ec (1.06/100 participant-weeks) compared with ESBL-Kp (0.65/100 participant-weeks). Providing assistance for urinary and faecal excretion to the index case by household members increased the risk of ESBL-PE transmission (adjusted prevalence ratio 4.3; 95% CI 1.3-14.1).
CONCLUSIONS: ESBL-PE cases discharged from the hospital are an important source of ESBL-PE transmission within households. Most acquisition and transmission events occurred during the first 2 months after hospital discharge and were causally related to care activities at home, highlighting the importance of hygiene measures in community settings.
CLINICAL STUDY REGISTRATION: German Clinical Trials Register, DRKS-ID: DRKS00013250.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:27 |
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| Enthalten in: |
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases - 27(2021), 9 vom: 07. Sept., Seite 1322-1329 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Riccio, Maria E [VerfasserIn] |
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| Links: |
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| Themen: |
Acquisition |
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| Anmerkungen: |
Date Completed 07.01.2022 Date Revised 07.01.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.cmi.2020.12.024 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM319850927 |
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| 100 | 1 | |a Riccio, Maria E |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Household acquisition and transmission of extended-spectrum β-lactamase (ESBL) -producing Enterobacteriaceae after hospital discharge of ESBL-positive index patients |
| 264 | 1 | |c 2021 | |
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| 500 | |a Date Revised 07.01.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved. | ||
| 520 | |a OBJECTIVES: This study aimed to determine rates and risk factors of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) acquisition and transmission within households after hospital discharge of an ESBL-PE-positive index patient | ||
| 520 | |a METHODS: Two-year prospective cohort study in five European cities. Patients colonized with ESBL-producing Escherichia coli (ESBL-Ec) or Klebsiella pneumoniae (ESBL-Kp), and their household contacts were followed up for 4 months after hospital discharge of the index case. At each follow up, participants provided a faecal sample and personal information. ESBL-PE whole-genome sequences were compared using pairwise single nucleotide polymorphism-based analysis | ||
| 520 | |a RESULTS: We enrolled 71 index patients carrying ESBL-Ec (n = 45), ESBL-Kp (n = 20) or both (n = 6), and 102 household contacts. The incidence of any ESBL-PE acquisition among household members initially free of ESBL-PE was 1.9/100 participant-weeks at risk. Nineteen clonally related household transmissions occurred (case to contact: 13; contact to case: 6), with an overall rate of 1.18 transmissions/100 participant-weeks at risk. Most of the acquisition and transmission events occurred within the first 2 months after discharge. The rate of ESBL-Kp household transmission (1.16/100 participant-weeks) was higher than of ESBL-Ec (0.93/100 participant-weeks), whereas more acquisitions were noted for ESBL-Ec (1.06/100 participant-weeks) compared with ESBL-Kp (0.65/100 participant-weeks). Providing assistance for urinary and faecal excretion to the index case by household members increased the risk of ESBL-PE transmission (adjusted prevalence ratio 4.3; 95% CI 1.3-14.1) | ||
| 520 | |a CONCLUSIONS: ESBL-PE cases discharged from the hospital are an important source of ESBL-PE transmission within households. Most acquisition and transmission events occurred during the first 2 months after hospital discharge and were causally related to care activities at home, highlighting the importance of hygiene measures in community settings | ||
| 520 | |a CLINICAL STUDY REGISTRATION: German Clinical Trials Register, DRKS-ID: DRKS00013250 | ||
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| 650 | 4 | |a Prospective cohort study | |
| 650 | 4 | |a Transmission | |
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| 700 | 1 | |a Delgado, Mercedes |e verfasserin |4 aut | |
| 700 | 1 | |a Guther, Julia |e verfasserin |4 aut | |
| 700 | 1 | |a Peter, Silke |e verfasserin |4 aut | |
| 700 | 1 | |a Paganini, Julian |e verfasserin |4 aut | |
| 700 | 1 | |a Martischang, Romain |e verfasserin |4 aut | |
| 700 | 1 | |a Sauser, Julien |e verfasserin |4 aut | |
| 700 | 1 | |a de Kraker, Marlieke E A |e verfasserin |4 aut | |
| 700 | 1 | |a Cherkaoui, Abdessalam |e verfasserin |4 aut | |
| 700 | 1 | |a Fluit, Ad C |e verfasserin |4 aut | |
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| 700 | 1 | |a Eib, Michael |e investigator |4 oth | |
| 700 | 1 | |a Autenrieth, Ingo B |e investigator |4 oth | |
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| 700 | 1 | |a Scharringa, Jelle |e investigator |4 oth | |
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