title: Prevalence and Risk Factors for Colonization With Extended-Spectrum Cephalosporin-Resistant Escherichia coli in Children Attending Daycare Centers: A Cohort Study in the Netherlands.
abstract: BACKGROUND
  The purpose of this study was to determine the prevalence and risk factors for colonization with extended-spectrum cephalosporin-resistant (ESC-R) Escherichia coli in daycare center (DCC)-attending children.
  
  
  METHODS
  This is a prospective cohort study including 44 DCCs in the Netherlands, combining DCC characteristics and monthly collected stool samples from their attendees, and was performed in 2010-2012. During a 22-month study period, 852 stool samples were collected and screened for ESC-R E coli. Risk factors were studied using logistic regression analysis.
  
  
  RESULTS
  In DCC-attending children (<4 years old), the overall prevalence of ESC-R E coli was 4.5%, and it was 8% in <1-year-old attendees. Among the 38 children carrying ESC-R E coli, the most common types were blaCMY-2 (26%), blaCTX-M-1 (16%), and chromosomal AmpC type 3 promoter mutants (13%). Extended-spectrum cephalosporin-resistant E coli was less common in DCCs where stricter hygiene protocols were enforced, eg, not allowing ill children to enter the DCC (odds ratio [OR], 0.34; 95% confidence interval [CI], 0.14-0.84), performing extra checks on handwashing of ill children (OR, 0.42; 95% CI, 0.20-0.87), and reporting suspected outbreaks to local health authorities (OR, 0.27; 95% CI, 0.11-0.69).
  
  
  CONCLUSIONS
  The distribution of ESC-R E coli types in DCCs differs from that of the general population. Extended-spectrum cephalosporin-resistant E coli carriage in DCC-attending children is associated with the hygiene policies enforced in the DCC. Although our results are not conclusive enough to change current DCC practice beyond ensuring compliance with standing policies, they generated hypotheses and defined the degree of ESC resistance among DCC attendees, which may influence empiric antibiotic therapy choices, and tracked the increasing trend in ESC resistance.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: Maike
authors.initials: M
authors.lastname: Koningstein
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands Faculty of Medicine, Utrecht University, the Netherlands.
authors.forename: Margriet A
authors.initials: MA
authors.lastname: Leenen
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands Department of Infectious Diseases and Immunology, Utrecht University, Faculty of Veterinary Medicine, the Netherlands.
authors.forename: Lapo
authors.initials: L
authors.lastname: Mughini-Gras
authors.affiliation: Certe - Laboratory for Infectious Diseases, Department of Research and Development, Groningen, the Netherlands.
authors.forename: Rianne M C
authors.initials: RM
authors.lastname: Scholts
authors.affiliation: Certe - Laboratory for Infectious Diseases, Department of Research and Development, Groningen, the Netherlands.
authors.forename: Kirstin W
authors.initials: KW
authors.lastname: van Huisstede-Vlaanderen
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: Remko
authors.initials: R
authors.lastname: Enserink
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: Rody
authors.initials: R
authors.lastname: Zuidema
authors.affiliation: Certe - Laboratory for Infectious Diseases, Department of Research and Development, Groningen, the Netherlands Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, the Netherlands.
authors.forename: Mirjam A M D
authors.initials: MA
authors.lastname: Kooistra-Smid
authors.affiliation: Department of Bacteriology and TSEs, Central Veterinary Institute of Wageningen UR, Lelystad, the Netherlands.
authors.forename: Kees
authors.initials: K
authors.lastname: Veldman
authors.affiliation: Department of Bacteriology and TSEs, Central Veterinary Institute of Wageningen UR, Lelystad, the Netherlands Department of Infectious Diseases and Immunology, Utrecht University, Faculty of Veterinary Medicine, the Netherlands.
authors.forename: Dik
authors.initials: D
authors.lastname: Mevius
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: Wilfrid
authors.initials: W
authors.lastname: van Pelt
mesh_terms: D000900:Anti-Bacterial Agents; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology; D002511:Cephalosporins; D002656:Child Day Care Centers; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000145:classification / Q000187:drug effects*; D004927:Escherichia coli Infections / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D001618:beta-Lactamases
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D001618:beta-Lactamases
keywords: AmpC; ESBL; child daycare; extended-spectrum cephalosporin resistance; risk factors