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 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.
Division of Epidemiology, Tel-Aviv Sourasky Medical Centre, Tel-Aviv, Israel.
A
A
Adler
A
A
Baraniak
R
R
Izdebski
J
J
Fiett
A
A
Salvia
J V
JV
Samso
C
C
Lawrence
J
J
Solomon
M
M
Paul
Y
Y
Lerman
Y
Y
Schwartzberg
E
E
Mordechai
A
A
Rossini
J
J
Fierro
C
C
Lammens
S
S
Malhotra-Kumar
H
H
Goossens
W
W
Hryniewicz
C
C
Brun-Buisson
M
M
Gniadkowski
Y
Y
Carmeli
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002353:Carrier State / Q000453:epidemiology* / Q000635:transmission; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D004755:Enterobacteriaceae / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000635:transmission; D004926:Escherichia coli; D005060:Europe / Q000453:epidemiology; D005190:Family; D005243:Feces / Q000382:microbiology; D005260:Female; D005838:Genotype; D006282:Health Personnel; D006801:Humans; D007711:Klebsiella pneumoniae; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D058885:Multilocus Sequence Typing; D016133:Polymerase Chain Reaction; D015995:Prevalence; D011446:Prospective Studies; D012047:Rehabilitation Centers; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism*
D004269:DNA, Bacterial; D001618:beta-Lactamases
Carriage; extended spectrum β-lactamase; family members; healthcare workers; rehabilitation centres