A multinational study of colonization with extended spectrum β-lactamase-producing Enterobacteriaceae in healthcare personnel and family members of carrier patients hospitalized in rehabilitation centres

The study aims were: (i) to define the prevalence of and risk factors for colonization by extended spectrum β-lactamase (ESBL) -producing Enterobacteriaceae (EPE) among healthcare workers (HCWs) and family members (FMs) of EPE-colonized patients in rehabilitation units and (ii) to compare EPE isolat...

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Published in:	Clinical microbiology and infection Vol. 20; no. 8; pp. O516 - O523
Main Authors:	Adler, A., Baraniak, A., Izdebski, R., Fiett, J., Salvia, A., Samso, J.V., Lawrence, C., Solomon, J., Paul, M., Lerman, Y., Schwartzberg, Y., Mordechai, E., Rossini, A., Fierro, J., Lammens, C., Malhotra-Kumar, S., Goossens, H., Hryniewicz, W., Brun-Buisson, C., Gniadkowski, M., Carmeli, Y., for MOSAR team
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-08-2014
Subjects:	Adolescent Adult Aged Aged, 80 and over beta-Lactamases - secretion Carriage Carrier State - epidemiology Carrier State - transmission DNA, Bacterial - chemistry DNA, Bacterial - genetics Electrophoresis, Gel, Pulsed-Field Enterobacteriaceae Enterobacteriaceae - classification Enterobacteriaceae - enzymology Enterobacteriaceae - genetics Enterobacteriaceae - isolation & purification Enterobacteriaceae Infections - epidemiology Enterobacteriaceae Infections - transmission Escherichia coli Europe - epidemiology extended spectrum β-lactamase Family family members Feces - microbiology Female Genotype Health Personnel healthcare workers Humans Klebsiella pneumoniae Male Middle Aged Molecular Epidemiology Multilocus Sequence Typing Polymerase Chain Reaction Prevalence Prospective Studies Rehabilitation Centers rehabilitation centres Young Adult Europe family members extended spectrum β-lactamase healthcare workers rehabilitation centres Carriage
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Summary:	The study aims were: (i) to define the prevalence of and risk factors for colonization by extended spectrum β-lactamase (ESBL) -producing Enterobacteriaceae (EPE) among healthcare workers (HCWs) and family members (FMs) of EPE-colonized patients in rehabilitation units and (ii) to compare EPE isolates from these three groups. The study included 286 FMs of 194 EPE-carrying patients identified in five rehabilitation units located in Israel, Italy, France and Spain. The EPE were detected in rectal swabs from 26 (9%) of 286 FMs screened. In multivariate analyses, older age of FM, greater mean number of hours spent with the patient, being a daughter or a female spouse of a patient, and chronic lung disease of the patient were significantly associated with carriage in the FM. Escherichia coli was the most common organism (76%), followed by Klebsiella pneumoniae (19%). Isolates were typed by pulsed field gel electrophoresis and multilocus sequence typing, and ESBLs were identified by PCR sequencing. A comparison of paired species isolates from FMs and their respective patient showed that 17 of 23 strains were indistinguishable. EPE were detected in 35 (3.5%, E. coli = 34) of the 1001 HCWs screened. Feeding patients was associated with EPE carriage by HCWs. Only 7 of 23 E. coli subclones cultured from HCWs were also represented among 376 patient-derived ESBL-producing E. coli isolates from the same rehabilitation units. In Spain, a higher proportion of HCWs and FMs were ESBL carriers than elsewhere (p <0.05). In conclusion, the molecular and epidemiological data suggest that FMs are at higher risk of EPE acquisition from their relative patients than HCWs.
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ISSN:	1198-743X 1469-0691
DOI:	10.1111/1469-0691.12560