title: Transmission dynamics of ESBL-producing Escherichia coli clones in rehabilitation wards at a tertiary care centre.
abstract: Increasing resistance due to the production of ESBL in Escherichia coli (ESBL-E. coli) has become a major threat to public health. Our aims were to study the incidence of ESBL-E. coli acquisition during hospitalization and the transmission rates of different ESBL-E. coli clones. This was a prospective case-control study, conducted in two geriatric rehabilitation wards in Tel-Aviv. Serial rectal cultures were collected from admission till discharge. All patient-unique ESBL-E. coli isolates were subjected to molecular typing by PFGE, MLST and determination of ESBL genes. An acquisition of ESBL-E. coli was defined as traceable when a patient with the same ST, PFGE type and ESBL gene was hospitalized in the same ward in parallel to the acquisition case. ESBL-E. colis were recovered from 125 patients out of 492 enrolled: 52 were recovered upon admission, 59 acquired ESBL-E. coli during their stay, and there was undetermined status in 14 patients. A low Norton's score was associated with acquisition (O.R. 1.14 for each point, 95% C.I. 1.01-1.29, p < 0.05). ESBL-E. coli infections (n = 9) had occurred only in ESBL-E. coli carriers. The pandemic ST131 clone was the most common (48/125). The majority of the isolates (101/125) produced CTX-M-type ESBL. Of the 59 acquisition cases, 32 were traced to another patient. In-hospital dissemination was highest in the CTX-M-27-producing ST131 and the SHV-5-producing ST372 sub-clones (acquisition/admission ratios of 17/11 and 9/3, respectively), with almost all cases traced to other patients. In conclusion, most ESBL-E. coli acquisition cases were traceable to other patients. The transmission potential varied significantly between ESBL-E. coli clones.
authors.affiliation: Section of Epidemiology, Tel-Aviv Souraski Medical Center, Tel-Aviv, Israel. amosa@tasmc.health.gov.il
authors.forename: A
authors.initials: A
authors.lastname: Adler
authors.forename: M
authors.initials: M
authors.lastname: Gniadkowski
authors.forename: A
authors.initials: A
authors.lastname: Baraniak
authors.forename: R
authors.initials: R
authors.lastname: Izdebski
authors.forename: J
authors.initials: J
authors.lastname: Fiett
authors.forename: W
authors.initials: W
authors.lastname: Hryniewicz
authors.forename: S
authors.initials: S
authors.lastname: Malhotra-Kumar
authors.forename: H
authors.initials: H
authors.lastname: Goossens
authors.forename: C
authors.initials: C
authors.lastname: Lammens
authors.forename: Y
authors.initials: Y
authors.lastname: Lerman
authors.forename: M
authors.initials: M
authors.lastname: Kazma
authors.forename: T
authors.initials: T
authors.lastname: Kotlovsky
authors.forename: Y
authors.initials: Y
authors.lastname: Carmeli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016521:Electrophoresis, Gel, Pulsed-Field; D004926:Escherichia coli / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission*; D005260:Female; D005838:Genotype; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D017720:Molecular Epidemiology; D058885:Multilocus Sequence Typing; D011446:Prospective Studies; D012007:Rectum / Q000382:microbiology; D012047:Rehabilitation Centers; D062606:Tertiary Care Centers; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D001618:beta-Lactamases