TY - JOUR
T1 - Household acquisition and transmission of extended-spectrum β-lactamase (ESBL) -producing Enterobacteriaceae after hospital discharge of ESBL-positive index patients
AU - Riccio, Maria E.
AU - Verschuuren, Tess
AU - Conzelmann, Nadine
AU - Martak, Daniel
AU - Meunier, Alexandre
AU - Salamanca, Elena
AU - Delgado, Mercedes
AU - Guther, Julia
AU - Peter, Silke
AU - Paganini, Julian
AU - Martischang, Romain
AU - Sauser, Julien
AU - de Kraker, Marlieke E.A.
AU - Cherkaoui, Abdessalam
AU - Fluit, Ad C.
AU - Cooper, Ben S.
AU - Hocquet, Didier
AU - Kluytmans, Jan A.J.W.
AU - Tacconelli, Evelina
AU - Rodriguez-Baño, Jesús
AU - Harbarth, Stephan
AU - Brossier, Caroline
AU - von Dach, Elodie
AU - Renzi, Gesuele
AU - Schrenzel, Jacques
AU - Bunk, Stefanie
AU - Goepel, Siri
AU - Hölzl, Florian
AU - Eib, Michael
AU - Autenrieth, Ingo B.
AU - Pascual, Álvaro
AU - Bertrand, Xavier
AU - Scharringa, Jelle
AU - Musicha, Patrick
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Objectives: This study aimed to determine rates and risk factors of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) acquisition and transmission within households after hospital discharge of an ESBL-PE-positive index patient. Methods: Two-year prospective cohort study in five European cities. Patients colonized with ESBL-producing Escherichia coli (ESBL-Ec) or Klebsiella pneumoniae (ESBL-Kp), and their household contacts were followed up for 4 months after hospital discharge of the index case. At each follow up, participants provided a faecal sample and personal information. ESBL-PE whole-genome sequences were compared using pairwise single nucleotide polymorphism-based analysis. Results: We enrolled 71 index patients carrying ESBL-Ec (n = 45), ESBL-Kp (n = 20) or both (n = 6), and 102 household contacts. The incidence of any ESBL-PE acquisition among household members initially free of ESBL-PE was 1.9/100 participant-weeks at risk. Nineteen clonally related household transmissions occurred (case to contact: 13; contact to case: 6), with an overall rate of 1.18 transmissions/100 participant-weeks at risk. Most of the acquisition and transmission events occurred within the first 2 months after discharge. The rate of ESBL-Kp household transmission (1.16/100 participant-weeks) was higher than of ESBL-Ec (0.93/100 participant-weeks), whereas more acquisitions were noted for ESBL-Ec (1.06/100 participant-weeks) compared with ESBL-Kp (0.65/100 participant-weeks). Providing assistance for urinary and faecal excretion to the index case by household members increased the risk of ESBL-PE transmission (adjusted prevalence ratio 4.3; 95% CI 1.3–14.1). Conclusions: ESBL-PE cases discharged from the hospital are an important source of ESBL-PE transmission within households. Most acquisition and transmission events occurred during the first 2 months after hospital discharge and were causally related to care activities at home, highlighting the importance of hygiene measures in community settings. Clinical study registration: German Clinical Trials Register, DRKS-ID: DRKS00013250.
AB - Objectives: This study aimed to determine rates and risk factors of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) acquisition and transmission within households after hospital discharge of an ESBL-PE-positive index patient. Methods: Two-year prospective cohort study in five European cities. Patients colonized with ESBL-producing Escherichia coli (ESBL-Ec) or Klebsiella pneumoniae (ESBL-Kp), and their household contacts were followed up for 4 months after hospital discharge of the index case. At each follow up, participants provided a faecal sample and personal information. ESBL-PE whole-genome sequences were compared using pairwise single nucleotide polymorphism-based analysis. Results: We enrolled 71 index patients carrying ESBL-Ec (n = 45), ESBL-Kp (n = 20) or both (n = 6), and 102 household contacts. The incidence of any ESBL-PE acquisition among household members initially free of ESBL-PE was 1.9/100 participant-weeks at risk. Nineteen clonally related household transmissions occurred (case to contact: 13; contact to case: 6), with an overall rate of 1.18 transmissions/100 participant-weeks at risk. Most of the acquisition and transmission events occurred within the first 2 months after discharge. The rate of ESBL-Kp household transmission (1.16/100 participant-weeks) was higher than of ESBL-Ec (0.93/100 participant-weeks), whereas more acquisitions were noted for ESBL-Ec (1.06/100 participant-weeks) compared with ESBL-Kp (0.65/100 participant-weeks). Providing assistance for urinary and faecal excretion to the index case by household members increased the risk of ESBL-PE transmission (adjusted prevalence ratio 4.3; 95% CI 1.3–14.1). Conclusions: ESBL-PE cases discharged from the hospital are an important source of ESBL-PE transmission within households. Most acquisition and transmission events occurred during the first 2 months after hospital discharge and were causally related to care activities at home, highlighting the importance of hygiene measures in community settings. Clinical study registration: German Clinical Trials Register, DRKS-ID: DRKS00013250.
KW - Acquisition
KW - Extended-spectrum β-lactamase
KW - Household
KW - Prospective cohort study
KW - Transmission
U2 - 10.1016/j.cmi.2020.12.024
DO - 10.1016/j.cmi.2020.12.024
M3 - Article
SN - 1198-743X
VL - 27
SP - 1322
EP - 1329
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 9
ER -