title: Prolonged colonisation with Escherichia coli O25:ST131 versus other extended-spectrum beta-lactamase-producing E. coli in a long-term care facility with high endemic level of rectal colonisation, the Netherlands, 2013 to 2014.
abstract: The extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli clone ST131 (ESBL-ST131) has spread in healthcare settings worldwide. The reasons for its successful spread are unknown, but might include more effective transmission and/or longer persistence. We evaluated the colonisation dynamics of ESBL-producing E. coli (ESBL-EC), including ESBL-ST131, in a long-term care facility (LTCF) with an unusually high prevalence of rectal ESBL-EC colonisation. During a 14-month period, rectal or faecal samples were obtained from 296 residents during six repetitive prevalence surveys, using ESBL-selective culture. Transmission rates, reproduction numbers, and durations of colonisation were compared for ESBL-ST131 vs other ESBL-EC. Furthermore, the likely time required for ESBL-ST131 to disappear from the LTCF was estimated. Over time, the endemic level of ESBL-ST131 remained elevated whereas other ESBL-EC returned to low-level prevalence, despite comparable transmission rates. Survival analysis showed a half-life of 13 months for ESBL-ST131 carriage, vs two to three months for other ESBL-EC (p < 0.001). Per-admission reproduction numbers were 0.66 for ESBL-ST131 vs 0.56 for other ESBL-EC, predicting a mean time of three to four years for ESBL-ST131 to disappear from the LTCF under current conditions. Transmission rates were comparable for ESBL-ST131 vs other ESBL-EC. Prolonged rectal carriage explained the persistence of ESBL-ST131 in the LTCF.
authors: Laboratory for Medical Microbiology, Stichting PAMM, Veldhoven, the Netherlands.
authors: Ilse
authors: I
authors: Overdevest
authors: Manon
authors: M
authors: Haverkate
authors: Jacobien
authors: J
authors: Veenemans
authors: Yvonne
authors: Y
authors: Hendriks
authors: Carlo
authors: C
authors: Verhulst
authors: Ans
authors: A
authors: Mulders
authors: Willemijn
authors: W
authors: Couprie
authors: Martin
authors: M
authors: Bootsma
authors: James
authors: J
authors: Johnson
authors: Jan
authors: J
authors: Kluytmans
mesh_terms: D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D004926:Escherichia coli / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces; D005260:Female; D005838:Genotype; D006801:Humans; D007902:Length of Stay; D008134:Long-Term Care; D017720:Molecular Epidemiology; D009426:Netherlands / Q000453:epidemiology; D009735:Nursing Homes; D016133:Polymerase Chain Reaction; D015995:Prevalence; D011446:Prospective Studies; D012007:Rectum / Q000382:microbiology*; D001618:beta-Lactamases / Q000096:biosynthesis
chemical_list: D001618:beta-Lactamases
keywords: ESBL; Escherichia coli; Long-term care facility; ST131 E. coli; colonization; epidemiology; outbreak; transmission