title: Extended-spectrum β-lactamase- and pAmpC-producing Enterobacteriaceae among the general population in a livestock-dense area.
abstract: OBJECTIVE
  In the Netherlands there is an ongoing debate regarding environmental health risks of livestock farming for neighbouring residents. This explorative study aims to determine the prevalence of carriage of extended-spectrum β-lactamase and/or plasmid-mediated AmpC-producing Enterobacteriaceae (ESBL/pAmpC-E) in the general population living in a livestock-dense area, and to study associations between determinants, including exposure through contact with animals and the environment, and human carriage of ESBL/pAmpC-E.
  
  
  METHODS
  A cross-sectional study was performed among 2432 adults (aged 20-72 years) in 12 temporary research centres in the south of the Netherlands, consisting of a questionnaire and analysis of a faecal sample to assess carriage of ESBL/pAmpC-E. Risk factors were analysed using logistic regression.
  
  
  RESULTS
  The prevalence for carriage of ESBL/pAmpC-E was 4.5% (109/2432; 95% CI 3.7-5.4) ranging from 1.4% to 10.9% among the research centres. ESBL/pAmpC resistance genes were detected in Escherichia coli and Klebsiella pneumoniae isolates obtained from these 109 persons and the most common ESBL-resistance genes were blaCTX-M-15, blaCTX-M-14/17and blaCTX-M-1, originating from 76 participants. Travel in the previous 12 months to Africa, Asia or Latin America (OR 2.82; 95% CI 1.71-4.63), having kept cows for a hobby in the previous 5 years (OR 3.77; 95% CI 1.22-11.64), usage of proton-pump inhibitors (OR 1.84; 95% CI 1.05-3.23), and living within 1000 m of a mink farm (OR 2.26; 95% CI 1.28-3.98) were identified as risk factors. Exposure to poultry was not identified as a risk factor.
  
  
  CONCLUSIONS
  Overall, living in close proximity to livestock animals and farms does not seem to be a risk factor for carriage of ESBL/pAmpC-E.
authors: Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment, Bilthoven, The Netherlands. Electronic address: lieke.wielders@rivm.nl.
authors: C C H
authors: CCH
authors: Wielders
authors: Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors: A H A M
authors: AHAM
authors: van Hoek
authors: Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors: P D
authors: PD
authors: Hengeveld
authors: Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors: C
authors: C
authors: Veenman
authors: Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors: C M
authors: CM
authors: Dierikx
authors: Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors: T P
authors: TP
authors: Zomer
authors: Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands.
authors: L A M
authors: LAM
authors: Smit
authors: Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors: W
authors: W
authors: van der Hoek
authors: Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands.
authors: D J
authors: DJ
authors: Heederik
authors: Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors: S C
authors: SC
authors: de Greeff
authors: Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors: C B M
authors: CBM
authors: Maassen
authors: Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors: E
authors: E
authors: van Duijkeren
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D001426:Bacterial Proteins / Q000235:genetics*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004755:Enterobacteriaceae / Q000187:drug effects / Q000235:genetics*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology*; D004781:Environmental Exposure; D005843:Geography; D006801:Humans; D058751:Livestock; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D062486:Public Health Surveillance; D012307:Risk Factors; D055815:Young Adult; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D001426:Bacterial Proteins; C048795:AmpC beta-lactamases; D001618:beta-Lactamases
keywords: AmpC; Antimicrobial resistance; Environment; Extended-spectrum β-lactamases; Livestock farming; Prevalence; Risk factors; β-lactam resistance