Colonization with third-generation cephalosporin-resistant Enterobacteriaceae on hospital admission: prevalence and risk factors.
The objectives of this study were to prospectively assess the rectal carriage rate of third-generation cephalosporin-resistant Enterobacteriaceae (3GCREB) in non-ICU patients on hospital admission and to investigate resistance mechanisms and risk factors for carriage.



Adult patients were screened for 3GCREB carriage at six German tertiary care hospitals in 2014 using rectal swabs or stool samples. 3GCREB isolates were characterized by phenotypic and molecular methods. Each patient answered a questionnaire about potential risk factors for colonization with MDR organisms (MDROs). Univariable and multivariable risk factor analyses were performed to identify factors associated with 3GCREB carriage.



Of 4376 patients, 416 (9.5%) were 3GCREB carriers. Escherichia coli was the predominant species (79.1%). ESBLs of the CTX-M-1 group (67.3%) and the CTX-M-9 group (16.8%) were the most frequent β-lactamases. Five patients (0.11%) were colonized with carbapenemase-producing Enterobacteriaceae. The following risk factors were significantly associated with 3GCREB colonization in the multivariable analysis (P < 0.05): centre; previous MDRO colonization (OR = 2.12); antibiotic use within the previous 6 months (OR = 2.09); travel outside Europe (OR = 2.24); stay in a long-term care facility (OR = 1.33); and treatment of gastroesophageal reflux disease (GERD) (OR = 1.22).



To our knowledge, this is the largest admission prevalence study of 3GCREB in Europe. The observed prevalence of 9.5% 3GCREB carriage was higher than previously reported and differed significantly among centres. In addition to previously identified risk factors, the treatment of GERD proved to be an independent risk factor for 3GCREB colonization.
German Center for Infection Research (DZIF), Germany Institute for Medical Microbiology, Immunology and Hygiene, University Hospital Cologne, Cologne, Germany.
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A
Hamprecht
German Center for Infection Research (DZIF), Germany Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany.
A M
AM
Rohde
German Center for Infection Research (DZIF), Germany Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany.
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M
Behnke
German Center for Infection Research (DZIF), Germany Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany.
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S
Feihl
German Center for Infection Research (DZIF), Germany Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany.
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P
Gastmeier
German Center for Infection Research (DZIF), Germany Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany.
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F
Gebhardt
German Center for Infection Research (DZIF), Germany Division of Infectious Diseases, Department of Medicine II, University Medical Center Freiburg, Freiburg, Germany.
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Kern
German Center for Infection Research (DZIF), Germany Institute for Medical Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany.
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JK
Knobloch
German Center for Infection Research (DZIF), Germany Division of Infectious Diseases, Department of Medicine II, University Medical Center Freiburg, Freiburg, Germany.
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A
Mischnik
German Center for Infection Research (DZIF), Germany Institute for Medical Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany.
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B
Obermann
German Center for Infection Research (DZIF), Germany Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany.
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C
Querbach
German Center for Infection Research (DZIF), Germany Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany.
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S
Peter
German Center for Infection Research (DZIF), Germany Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, Freiburg, Germany.
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C
Schneider
German Center for Infection Research (DZIF), Germany Division of Infectious Diseases, Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany.
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W
Schröder
German Center for Infection Research (DZIF), Germany Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany.
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F
Schwab
German Center for Infection Research (DZIF), Germany Division of Infectious Diseases, Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany.
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E
Tacconelli
German Center for Infection Research (DZIF), Germany Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany.
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M
Wiese-Posselt
German Center for Infection Research (DZIF), Germany Institute for Medical Microbiology, Immunology and Hygiene, University Hospital Cologne, Cologne, Germany.
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T
Wille
German Center for Infection Research (DZIF), Germany Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany.
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M
Willmann
German Center for Infection Research (DZIF), Germany Institute for Medical Microbiology, Immunology and Hygiene, University Hospital Cologne, Cologne, Germany harald.seifert@uni-koeln.de.
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H
Seifert
German Center for Infection Research (DZIF), Germany Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany Department of Hospital Hygiene and Infection Control, University Hospital Cologne, Cologne, Germany.
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J
Zweigner
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D002511:Cephalosporins; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D004927:Escherichia coli Infections / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D015995:Prevalence; D011446:Prospective Studies; D012007:Rectum / Q000382:microbiology*; D012307:Risk Factors
D000900:Anti-Bacterial Agents; D002511:Cephalosporins