High prevalence of multidrug resistant Enterobacteriaceae among residents of long term care facilities in Amsterdam, the Netherlands
Autoři:
Eline van Dulm aff001; Aletta T. R. Tholen aff002; Annika Pettersson aff003; Martijn S. van Rooijen aff001; Ina Willemsen aff004; Peter Molenaar aff005; Marjolein Damen aff006; Paul Gruteke aff007; Paul Oostvogel aff001; Ed J. Kuijper aff008; Cees M. P. M. Hertogh aff009; Christina M. J. E. Vandenbroucke-Grauls aff003; Maarten Scholing aff007
Působiště autorů:
Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
aff001; Centre for Zoonoses and Environmental Microbiology, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
aff002; Department of Medical Microbiology and Infection Control, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
aff003; Department of Medical Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands
aff004; National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
aff005; Department of Medical Microbiology, Maasstad General Hospital, Rotterdam, the Netherlands
aff006; Department of Medical Microbiology, OLVG Lab BV, Amsterdam, the Netherlands
aff007; Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
aff008; Department of General Practice & Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
aff009
Vyšlo v časopise:
PLoS ONE 14(9)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0222200
Souhrn
Introduction
The aim of this study was to determine the rate of asymptomatic carriage and spread of multidrug-resistant micro-organisms (MDRO) and to identify risk factors for extended spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) carriage in 12 long term care facilities (LTCFs) in Amsterdam, the Netherlands.
Materials and methods
From November 2014 to august 2015, feces and nasal swabs from residents from LTCFs in Amsterdam, the Netherlands were collected and analyzed for presence of multidrug-resistant Gram-negative bacteria (MDRGN), including ESBL-E, carbapenemase-producing Enterobacteriaceae (CPE), colistin-resistant Enterobacteriaceae and methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Logistic regression analysis was performed to assess associations between variables and ESBL-carriage.
Results
In total, 385 residents from 12 LTCFs (range 15–48 residents per LTCF) were enrolled. The prevalence of carriage of MDRGN was 18.2% (range among LTCFs 0–47%) and the prevalence of ESBL-E alone was 14.5% (range among LTCFs: 0–34%). Of 63 MDRGN positive residents, 50 (79%) were ESBL-E positive of which 43 (86%) produced CTX-M. Among 44 residents with ESBL-E positive fecal samples of whom data on contact precautions were available at the time of sampling, only 9 (20%) were already known as ESBL-E carriers. The prevalence for carriage of MRSA was 0.8% (range per LTCF: 0–7%) and VRE 0%. One CPE colonized resident was found. All fecal samples tested negative for presence of plasmid mediated resistance for colistin (MCR-1). Typing of isolates by Amplified Fragment Length Polymorphism (AFLP) showed five MDRGN clusters, of which one was found in multiple LTCFs and four were found in single LTCFs, suggesting transmission within and between LTCFs. In multivariate analysis only the presence of MDRO in the preceding year remained a risk factor for ESBL-E carriage.
Conclusions
The ESBL-carriage rate of residents in LTCFs is nearly two times higher than in the general population but varies considerably among LTCFs in Amsterdam, whereas carriage of MRSA and VRE is low. The majority (80%) of ESBL-E positive residents had not been detected by routine culture of clinical specimens at time of sampling. Current infection control practices in LTCFs in Amsterdam do not prevent transmission. Both improvement of basic hygiene, and funding for laboratory screening, should allow LTCFs in Amsterdam to develop standards of care to prevent transmission of ESBL-E.
Klíčová slova:
Biology and life sciences – Organisms – Bacteria – Staphylococcus – Staphylococcus aureus – Methicillin-resistant Staphylococcus aureus – Enterobacteriaceae – Microbiology – Medical microbiology – Microbial pathogens – Bacterial pathogens – Microbial control – Molecular biology – Molecular biology techniques – Artificial gene amplification and extension – Amplified fragment length polymorphism – Polymerase chain reaction – Medicine and health sciences – Pathology and laboratory medicine – Pathogens – Epidemiology – Medical risk factors – Pharmacology – Antimicrobial resistance – Antibiotic resistance – Health care – Health care facilities – Nursing homes – Hospitals – Research and analysis methods
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Článek vyšel v časopise
PLOS One
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