title: Detection of Healthcare-Related Extended-Spectrum Beta-Lactamase-Producing Escherichia coli Transmission Events Using Combined Genetic and Phenotypic Epidemiology.
abstract: BACKGROUND
  Since the year 2000 there has been a sharp increase in the prevalence of healthcare-related infections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. However, the high community prevalence of ESBL-producing E. coli isolates means that many E. coli typing techniques may not be suitable for detecting E. coli transmission events. Therefore, we investigated if High-throughput MultiLocus Sequence Typing (HiMLST) and/or Raman spectroscopy were suitable techniques for detecting recent E. coli transmission events.
  
  
  METHODS
  This study was conducted from January until December 2010 at Erasmus University Medical Center, Rotterdam, the Netherlands. Isolates were typed using HiMLST and Raman spectroscopy. A genetic cluster was defined as two or more patients carrying identical isolates. We used predefined definitions for epidemiological relatedness to assess healthcare-related transmission.
  
  
  RESULTS
  We included 194 patients; strains of 112 patients were typed using HiMLST and strains of 194 patients were typed using Raman spectroscopy. Raman spectroscopy identified 16 clusters while HiMLST identified 10 clusters. However, no healthcare-related transmission events were detected. When combining data from both typing techniques, we identified eight clusters (n = 34 patients), as well as 78 patients with a non-cluster isolate. However, we could not detect any healthcare-related transmission in these 8 clusters.
  
  
  CONCLUSIONS
  Although clusters were genetically detected using HiMLST and Raman spectroscopy, no definite epidemiological relationships could be demonstrated which makes the possibility of healthcare-related transmission events highly unlikely. Our results suggest that typing of ESBL-producing E. coli using HiMLST and/or Raman spectroscopy is not helpful in detecting E. coli healthcare-related transmission events.
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Anne F
authors.initials: AF
authors.lastname: Voor In 't Holt
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Agnes A
authors.initials: AA
authors.lastname: Wattel
authors.affiliation: Department of Molecular Biology, Regional Laboratory of Public Health, Haarlem, The Netherlands.
authors.forename: Stefan A
authors.initials: SA
authors.lastname: Boers
authors.affiliation: Department of Molecular Biology, Regional Laboratory of Public Health, Haarlem, The Netherlands.
authors.forename: Ruud
authors.initials: R
authors.lastname: Jansen
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: John P
authors.initials: JP
authors.lastname: Hays
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Wil H F
authors.initials: WH
authors.lastname: Goessens
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Margreet C
authors.initials: MC
authors.lastname: Vos
mesh_terms: D015373:Bacterial Typing Techniques / Q000379:methods; D004926:Escherichia coli / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D006801:Humans; D017757:Infectious Disease Transmission, Professional-to-Patient; D016133:Polymerase Chain Reaction / Q000379:methods; D013059:Spectrum Analysis, Raman / Q000379:methods; D001618:beta-Lactamases / Q000235:genetics* / Q000378:metabolism
chemical_list: D001618:beta-Lactamases