Epidemiology of ESBL-producing Escherichia Coli from Repeated Prevalence Studies over 11 years in a Long-term-care Facility

Overview

Journal Antimicrob Resist Infect Control

Publisher Biomed Central

Specialty Infectious Diseases

Date 2021 Oct 20

PMID 34666836

Citations 10

Authors

Romain Martischang

Patrice Francois

Abdessalam Cherkaoui

Nadia Gaia

Gesuele Renzi

Americo Agostinho

Monica Perez

Christophe E Graf

Stephan Harbarth

Affiliations

Soon will be listed here.

Abstract

Background: Escherichia coli sequence type (ST) 131 H30 is an emerging multidrug resistant subclone, known to spread and cause outbreaks in long-term care facilities (LTCFs).

Objectives And Methods: From 2010 through 2020, we performed 11 yearly surveillance studies for determining the prevalence of digestive carriage of ESBL-producing E. coli (ESBL-EC) among residents in a university-affiliated LCTF. Sequencing and genotyping of selected isolates were performed to characterize temporal trends in the prevalence and epidemic potential of ESBL-EC subclones, and for evaluating a potential rebound effect following discontinuation of contact precautions for ESBL-EC carriers in January 2019.

Results: This study included 2'403 LTCF residents, with 252 (10.5%) positive for ESBL-EC. Among the 236 ESBL-EC isolates available for typing, 58.0% belonged to the ST131 lineage, including 94/137 (68.6%) ST131 H30 isolates. An increasing yearly prevalence was observed for ESBL-EC (from 4.6 to 9.4%; p = 0.11), but not for the ST131 H30 subclone, which peaked in 2015 and declined thereafter. Multiple previously unnoticed ESBL-EC outbreaks occurred in the LTCF. Since 2018, we noted the clonal expansion of a rare ST131 H89 subclone (O16:H5) harboring CTX-M-14 and CTX-M-24. No rebound effect was observed in ESBL-EC prevalence nor in the different subclones following discontinuation of contact precautions for ESBL-EC carriers since 2019.

Conclusion: Clonal fluctuation was observed for ST131 H30 ESBL-EC with a current decline in prevalence. Surveillance should include the evolution of ST131 non-H30 subclones, which may spread in LTCFs. Our findings suggest that discontinuation of contact precautions for ESBL-EC carriers in LTCFs may be safely implemented, in support of European recommendations to limit ESBL-producing Enterobacteriaceae control measures in endemic settings to non-E. coli.

Citing Articles

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Global prevalence of human intestinal carriage of ESBL-producing during and after the COVID-19 pandemic.

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Regional spread of an atypical ESBL-producing ST131H89 clone among different human and environmental reservoirs in Western Switzerland.

Martischang R, Seth-Smith H, Verschuuren T, Hequet D, Gaia N, Francois P Antimicrob Agents Chemother. 2024; 68(2):e0092523.

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