4.7 Article

Household acquisition and transmission of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae after hospital discharge of ESBL-positive index patients

期刊

CLINICAL MICROBIOLOGY AND INFECTION
卷 27, 期 9, 页码 1322-1329

出版社

ELSEVIER SCI LTD
DOI: 10.1016/j.cmi.2020.12.024

关键词

Acquisition; Extended-spectrum beta-lactamase; Household; Prospective cohort study; Transmission

资金

  1. Instituto de Salud Carlos III [AC16/00076]
  2. Netherlands Organization for Health Research and Development [AC681055]
  3. Swiss National Science Foundation [40AR40-173608]
  4. German Federal Ministry of Education and Research [01KI1830]
  5. Agence Nationale de la Recherche [ANR-16-JPEC-0007-03]
  6. Innovative Medicines Initiative Joint Undertaking from the European Union's 7th Framework Pro-gramme (FP7/20072013) [115523, 115620, 115737]
  7. European Federation of Pharmaceutical Industries and associations companies'in-kind contribution
  8. Plan Nacional de I+D+i
  9. Instituto de Salud Carlos III
  10. Subdireccion General de Redes y Centros de Investigacion Cooperativa, Ministerio de Ciencia, Innovacion y Universidades
  11. Spanish Network for Research in Infectious Diseases [REIPI RD16/0016/0001]
  12. European Development Regional Fund 'A way to achieve Europe', Operative Programme Intelligence Growth
  13. Swiss National Science Foundation (SNF) [40AR40_173608] Funding Source: Swiss National Science Foundation (SNF)
  14. MRC [MR/R004536/1] Funding Source: UKRI

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The study found that ESBL-PE positive index patients discharged from hospitals are significant sources of ESBL-PE transmission within households, particularly during the first two months after discharge. The household transmission rate of ESBL-Kp was higher than ESBL-Ec, although there were more acquisitions of ESBL-Ec. Assisting the index patient with urinary and fecal excretions increased the risk of ESBL-PE transmission.
Objectives: This study aimed to determine rates and risk factors of extended-spectrum beta-lactamaseproducing 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. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.

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