title: Colonisation with extended-spectrum beta-lactamase (ESBL) not detected in a prevalence study.
abstract: BACKGROUND
  The Mid-West of Ireland has higher than average national rates of invasive extended-spectrum beta-lactamase (ESBL) bloodstream infections and carbapenemase-producing Enterobacteriaceae (CPE), with increasing numbers of ESBL isolates detected in community-dwelling patients.
  
  
  OBJECTIVE
  To conduct a point prevalence study in a convenience sample of the Mid-West population with the aim of determining the extent of ESBL colonisation.
  
  
  METHODS
  Utilising anonymised community stool samples that had completed routine analysis, we conducted a point prevalence study over a 4-week period on all samples that met defined inclusion and exclusion criteria. Limited epidemiological data was recorded: (1) age of patient, (2) gender, and (3) sender location. From these stool specimens, rectal swabs were inoculated (eSwab™ 480CE, Copan, Italy), which were subsequently cultured on selective chromogenic agar (Colorex™ ESBL). Culture plates were incubated aerobically at 37 °C for 24 h.
  
  
  RESULTS
  Of 195 samples processed, 58 % (n = 112) were from females. The median patient age was 62.4 years (range 20-94 years). 186 samples (95 %) originated from general practitioner clinics. During the study period, only nine eligible stool samples were received from LTCF (6 public). From 195 Colorex™ ESBL chromogenic agar plates cultured, no ESBL-producing organisms were detected.
  
  
  CONCLUSIONS
  This community point prevalence study did not identify ESBL colonisation despite high numbers of patients with invasive ESBL bloodstream infections presenting for admission in our institution. We believe this may be because of our small sample size. Data regarding antimicrobial exposure and other risk factors for ESBL colonisation were also not available. We remain vigilant for ESBL-producing organisms.
authors.affiliation: Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland.|Centre for Interventions in Infection, Inflammation and Immunity (4i) and Graduate-Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: O'Connor
authors.affiliation: Centre for Interventions in Infection, Inflammation and Immunity (4i) and Graduate-Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: M G
authors.initials: MG
authors.lastname: Kiernan
authors.affiliation: Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: Finnegan
authors.affiliation: Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Powell
authors.affiliation: Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland.
authors.forename: L
authors.initials: L
authors.lastname: Power
authors.affiliation: Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland.|Centre for Interventions in Infection, Inflammation and Immunity (4i) and Graduate-Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: N H
authors.initials: NH
authors.lastname: O'Connell
authors.affiliation: Centre for Interventions in Infection, Inflammation and Immunity (4i) and Graduate-Entry Medical School, University of Limerick, Limerick, Ireland. colum.dunne@ul.ie.
authors.forename: C P
authors.initials: CP
authors.lastname: Dunne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D055815:Young Adult; D001618:beta-Lactamases / Q000009:adverse effects* / Q000276:immunology
chemical_list: D001618:beta-Lactamases
keywords: Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae; Ireland; Point prevalence study; Rectal carriage