title: Extensive dissemination of extended spectrum β-lactamase-producing Enterobacteriaceae in a Dutch nursing home.
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).
  
  
  METHODS
  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.
  
  
  METHODS
  A nursing home (NH) in the southern Netherlands.
  
  
  METHODS
  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 bla CTX-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 bla CTX-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.
authors.affiliation: 1Laboratory for Microbiology and Infection Control,Amphia Hospital,Breda,The Netherlands.
authors.forename: Ina
authors.initials: I
authors.lastname: Willemsen
authors.affiliation: 2Department for Infection Control and Microbiology,St. Elisabeth Hospital,Tilburg,The Netherlands.
authors.forename: Jolande
authors.initials: J
authors.lastname: Nelson
authors.affiliation: 1Laboratory for Microbiology and Infection Control,Amphia Hospital,Breda,The Netherlands.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Hendriks
authors.affiliation: 3THEBE,Healthcare Organisation including Nursing Homes,Breda,The Netherlands.
authors.forename: Ans
authors.initials: A
authors.lastname: Mulders
authors.affiliation: 3THEBE,Healthcare Organisation including Nursing Homes,Breda,The Netherlands.
authors.forename: Sandrien
authors.initials: S
authors.lastname: Verhoeff
authors.affiliation: 4Amphia Academy,Amphia Hospital,Breda,The Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Mulder
authors.affiliation: 5Department for Medical Microbiology and Infection control,VUmc Medical Center,Amsterdam,The Netherlands.
authors.forename: Robert
authors.initials: R
authors.lastname: Roosendaal
authors.affiliation: 6Center for Infectious Disease Control,National Institute for Public Health and the Environment (RIVM),Bilthoven,The Netherlands.
authors.forename: Kim
authors.initials: K
authors.lastname: van der Zwaluw
authors.affiliation: 1Laboratory for Microbiology and Infection Control,Amphia Hospital,Breda,The Netherlands.
authors.forename: Carlo
authors.initials: C
authors.lastname: Verhulst
authors.affiliation: 7Amphia Academy Infectious Disease Foundation,Amphia Hospital,Breda,The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Kluytmans-van den Bergh
authors.affiliation: 1Laboratory for Microbiology and Infection Control,Amphia Hospital,Breda,The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Kluytmans
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission*; D003430:Cross-Sectional Studies; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission*; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D009735:Nursing Homes / Q000706:statistics & numerical data; D012007:Rectum / Q000382:microbiology; D012307:Risk Factors; D018440:beta-Lactam Resistance