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Extensive Dissemination of Extended Spectrum β-Lactamase–Producing Enterobacteriaceae in a Dutch Nursing Home

Published online by Cambridge University Press:  05 January 2015

Ina Willemsen ,
Jolande Nelson ,
Yvonne Hendriks ,
Ans Mulders ,
Sandrien Verhoeff ,
Paul Mulder ,
Robert Roosendaal ,
Kim van der Zwaluw ,
Carlo Verhulst  and
Marjolein Kluytmans-van den Bergh
...Show all authors
Ina Willemsen*
Affiliation:
Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands
Jolande Nelson
Affiliation:
Department for Infection Control and Microbiology, St. Elisabeth Hospital, Tilburg, The Netherlands
Yvonne Hendriks
Affiliation:
Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands
Ans Mulders
Affiliation:
THEBE, Healthcare Organisation including Nursing Homes, Breda, The Netherlands
Sandrien Verhoeff
Affiliation:
THEBE, Healthcare Organisation including Nursing Homes, Breda, The Netherlands
Paul Mulder
Affiliation:
Amphia Academy, Amphia Hospital, Breda, The Netherlands
Robert Roosendaal
Affiliation:
Department for Medical Microbiology and Infection control, VUmc Medical Center, Amsterdam, The Netherlands
Kim van der Zwaluw
Affiliation:
Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
Carlo Verhulst
Affiliation:
Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands
Marjolein Kluytmans-van den Bergh
Affiliation:
Amphia Academy Infectious Disease Foundation, Amphia Hospital, Breda, The Netherlands Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
Jan Kluytmans
Affiliation:
Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands Department for Medical Microbiology and Infection control, VUmc Medical Center, Amsterdam, The Netherlands Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
*
Address all correspondence to I. Willemsen, Laboratory for Microbiology and Infection Control, Amphia Hospital, PO Box 90158, 4800 RK Breda, The Netherlands ([email protected]).
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Abstract

OBJECTIVE

Risk factors for rectal carriage of ESBL-E and transmission were investigated in an outbreak of extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL-E).

DESIGN

Rectal carriage of ESBL-E was determined in a cross-sectional survey by culture of perianal swabs or fecal samples. Both phenotypical and genotypical methods were used to detect the production of ESBL. Nosocomial transmission was defined as the presence of genotypically related strains in ≥2 residents within the NH. Patient characteristics and variables in infection control practices were registered to investigate risk factors for transmission.

SETTING

A nursing home (NH) in the southern Netherlands.

PARTICIPANTS

Of 189 residents, 160 residents (84.7%) were screened for ESBL-E carriage. Of these 160 residents, 33 (20.6%) were ESBL-E positive. ESBL carriage rates varied substantially between wards (range, 0–47%). Four different ESBL-E clusters were observed. A blaCTX-M1-15 positive E. coli ST131 constituted the largest cluster (n=21) and was found in multiple wards (n=7).

RESULTS

Our investigation revealed extensive clonal dissemination of blaCTX-M1-15-positive E. coli ST131 in a nursing home. Unexplained differences in ESBL prevalence were detected among the wards.

CONCLUSIONS

As NHs constitute potential sources of multidrug-resistant bacteria, it is important to gain a better understanding of the risks factors and routes of transmission of ESBL-E.

Infect Control Hosp Epidemiol 2014;00(0): 1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 4 , April 2015 , pp. 394 - 400
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Huttner, A, Harbarth, S, Carlet, J, et al. Antimicrobial resistance; a global view from the 2013 World Healthcare-Associated Infections Forum. Antimicrob Resist Infect Control 2013;2:31.Google Scholar
2. Livermore, DM, Canton, R, Gniadkowski, M, et al. CTX-M: changing the face of ESBLs in Europe. J Antimicrob Chemother 2007;59:165–174.Google Scholar
3. Banerjee, R, Johnston, B, Lohse, C, et al. Escherichia coli sequence type 131 is a dominant, antimicrobial-resistant clonal group associated with healthcare and elderly hosts. Infect Control Hosp Epidemiol 2013;34:361–369.CrossRefGoogle ScholarPubMed
4. Rooney, PJ, O’Leary, MC, Loughrey, AC, et al. Nursing homes as a reservoir of ESBL ciprofloxacin resistant Escherichia coli. J Antimicrob Chemother 2009;64:635–641.CrossRefGoogle ScholarPubMed
5. Jans, B, Schoevaerdts, D, Huang, TD, et al. Epidemiology of multidrug-resistant microorganism among nursing home residents in Belgium. PLoS One 2013;8:e64908.Google Scholar
6. Lautenbach, E, Han, J, Santana, E, et al. Colonization with extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella species in long-term care facility residents. Infect Control Hosp Epidemiol 2012;33:302–304.Google Scholar
7. Strausbaugh, LJ, Crossley, KB, Nurse, BA, Thrupp, LD. Antimicrobial resistance in long-term-care facilities. Infect Control Hosp Epidemiol 1996;17:129–140.Google Scholar
8. Willemsen, I, Nelson-Melching, J, Hendriks, Y, et al. Measuring the quality of infection control in Dutch nursing homes using a standardized method; the Infection prevention RIsk Scan (IRIS). Antimicrob Resist Infect Control 2014;18(3):26.Google Scholar
9. Overdevest, ITMA, Willemsen, I, Elberts, S, Verhulst, C. Kluytmans JAJW. Laboratory detection of extended-spectrum β-lactamase-producing Enterobacteriaceae: evaluation of two screening agar plates and two confirmation techniques. J Clin Microbiol 2011;49:519–522.Google Scholar
10. Bernards, AT, Bonten, MJM, Cohen Stuart, J, et al. NVMM guideline, laboratory detection of highly resistant microorganisms (HRMO). http://www.nvmm.nl/system/files/2012.11.15%20richtlijn%20BRMO%20%28version%202.0%29%20-%20RICHTLIJN.pdf. Published 2012. Accessed June 2014.Google Scholar
11. Cuzon, G, Naas, T, Bogaerts, P, Glupczynski, Y, Nordmann, P. Evaluation of a DNA microarray for the rapid detection of extended-spectrum β-lactamases (TEM, SHV and CTX-M), plasmid-mediated cephalosporinases (CMY-2-like, DNA, FOZ, ACC-1, ACT/MIR and CMY-1-like/MOX) and carbapenemases (KPC, OXA-48, VIM, IMP and NDM). J Antimicrob Chemother 2012;67:1865–1869.Google Scholar
12. Savelkoul, PH, Aarts, HJ, de Haas, J, et al. Amplified fragment-length polymorphism analysis: the state of an art. J Clin Microbiol 1999;37:3083–3091.Google Scholar
13. Wirth, T, Falush, D, Lan, R, et al. Sex and virulence in Escherichia coli: an evolutionary perspective. Mol Microbiol 2006;60:1136–1151.Google Scholar
14. Protocol Prevalence Surveillance Nosocomial Infections in Nursing Homes (SNIV) April/November 2014 [in Dutch] http://www.rivm.nl/dsresource?objectid=rivmp:240024&type=org&disposition=inline. Published 2014. Accessed December 19, 2014.Google Scholar
15. Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical site infectiosn 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;139:606–608.Google Scholar
16. Zorgzwaartepakket - ZZP (intensity of care), Nederlandse Rijksoverheid (Dutch government) http://www.rivm.nl/dsresource?objectid=rivmp:240868&type=org&disposition=inline. Accessed December 19, 2014.Google Scholar
17. Chronische ziekten en multimorbiditeit (chronic diseases and multimorbidity) nationaal kompas Volksgezondheid, Nederlandse Rijksoverheid (Dutch government) [in Dutch] http://www.regionaalkompas.nl/hart-voor-brabant/thema-s/bevolking/chronisch-zieken/?printversion=true. Published 2013. Accessed December 19, 2014.Google Scholar
18. Sherlock, O, O'Connell, N, Creamer, E, Humphreys, H. Is it really clean? An evaluation of the efficacy of four methods for determining hospital cleanliness. J Hosp Infect 2009;72:140–146.Google Scholar
19. Johnson, J, Johnston, B, Clabots, C, Kuskowski, M, Castanheira, M. Escherichia coli sequence type ST131 as the major cause of serious multidrug-resistant E. coli infections in the United States. Clin Infect Dis 2010;51:286–294.Google Scholar
20. Peirano, G, Pitout, J. Molecular epidemiology of Escherichia coli producing CTX-M-β lactamases: the wordwide emergence of clone ST131 O25:H4. Int J Antimicrob Agents 2009;35:316–321.Google Scholar
21. van der Donk, CF, Schols, JM, Driessen, CJ, Hagenouw, RG, Meulendijks, A, Stobberingh, EE. Prevalence and spread of multidrug resistant Escherichia coli isolates among nursing home residents in the southern part of The Netherlands. J Am Med Dir Assoc 2013;14:199–203.Google Scholar
22. Rodriquez, I, Thomas, K, Van Essen, A, et al. Chromosomal location of blaCTX-M genes in clinical isolates of Escherichia coli from Germany, The Netherlands and the UK. Int J Antimicrob Agents 2014;43:553–557.CrossRefGoogle Scholar
23. Petty, NK, Ben Zakour, NL, Stanton-Cook, M, et al. Global dissemination of a multidrug resistant Escherichia coli clone. Proc Natl Acad Sci USA 2014;111:5694–5699.Google Scholar
24. Johnson, JR, Urban, C, Weissman, SJ, et al. Molecular epidemiological analysis of Escherichia coli sequence type ST131 (O25:H4) and blaCTX-M-15 among extended-spectrum-β-lactamase-producing E. coli from the United States, 2000 to 2009. Antimicrob Agents Chemother 2012;56:2364–2370.Google Scholar
25. Titelman, E, Hasan, CM, Iversen, A, et al. Faecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae is common 12 months after infection and is related to strain factors. Clin Microbiol Infect 2014;20:O505–O515.Google Scholar
26. Cochard, H, Aubier, B, Quentin, R, van der Mee-Marquet, N. Réseau des Hygiénistes du Centre. Extended-spectrum β-lactamase-producing Enterobacteriaceae in French nursing homes: an association between high carriage rate among residents, environmental contamination, poor conformity with good hygiene practice, and putative resident-to-resident transmission. Infect Control Hosp Epidemiol 2014;35:384–389.Google Scholar