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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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