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Drivers of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales colonization among residents of long-term care facilities: a European multicentre prospective cohort study

Background - Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBL-PE) are highly prevalent in long-term care (LTCF) settings. In order to estimate the acquisition rate of ESBL-producing Escherichia coli and Klebsiella pneumoniae in LTCF settings, and identify clinical and environmen...

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Main Authors: Göpel, Siri (Author) , Guther, J. (Author) , Gladstone, B. P. (Author) , Conzelmann, N. (Author) , Bunk, S. (Author) , Terzer, Tobias (Author) , Verschuuren, T. D. (Author) , Martak, D. (Author) , Rivera, E. Salamanca (Author) , Autenrieth, Ingo B. (Author) , Peter, S. (Author) , Kluytmans, J. A. J. W. (Author) , Hocquet, D. (Author) , Rodriguez-Baño, J. (Author) , Tacconelli, E. (Author)
Format: Article (Journal)
Language:English
Published: March 2025
In: The journal of hospital infection
Year: 2025, Volume: 157, Pages: 67-74
ISSN:1532-2939
DOI:10.1016/j.jhin.2024.12.010
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.jhin.2024.12.010
Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S0195670125000015
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Author Notes:S. Göpel, J. Guther, B.P. Gladstone, N. Conzelmann, S. Bunk, T. Terzer, T.D. Verschuuren, D. Martak, E. Salamanca Rivera, I. B. Autenrieth, S. Peter, J.A.J.W. Kluytmans, D. Hocquet, J. Rodriguez-Baño, E. Tacconelli, MODERN WP1 Study Group
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Summary:Background - Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBL-PE) are highly prevalent in long-term care (LTCF) settings. In order to estimate the acquisition rate of ESBL-producing Escherichia coli and Klebsiella pneumoniae in LTCF settings, and identify clinical and environmental risk factors, a multi-centre, prospective cohort study was conducted in six LTCFs in Germany, France, Spain and the Netherlands. - Methods - Longitudinal screening of residents was performed over 32 weeks, collecting epidemiological and clinical data and environmental samples. The primary outcome was the rate of new acquisition of ESBL-PE among LTCF residents. Molecular epidemiology was studied using whole genome sequencing, and risk factor analysis was undertaken using logistic and Poisson regression models. - Results - In total, 299 residents provided 1958 samples during follow-up. The prevalence of ESBL-PE colonization at baseline was 16.4%, and the incidence of acquisition was 0.79 per 1000 resident-days, both with high variability between LTCFs. Age ≥80 years, vascular disease and antibiotic consumption within the preceding year were risk factors for baseline colonization. Lack of hand sanitizers and a low nurse:resident ratio were associated with colonization. The presence of medical devices was associated with risk of acquisition. Vascular disease, hemiplegia, antibiotic consumption, and non-availability of private bathrooms were associated with carriage of multiple sequence types (STs). The prevalence of ESBL-PE among environmental samples was 2%, exclusively in LTCFs with high prevalence among residents. Genetic analysis showed a high prevalence of ST10 E. coli and ST405 K. pneumoniae at two study sites. - Conclusion - Infection prevention interventions, including availability of hand sanitizers, the number of nurses per resident, and antimicrobial stewardship, constitute important measures to control ESBL-PE in LTCFs. Genome-based surveillance could guide targeted interventions.
Item Description:Online verfügbar: 07. Januar 2025, Artikelversion: 15. Februar 2025
Gesehen am 08.09.2025
Physical Description:Online Resource
ISSN:1532-2939
DOI:10.1016/j.jhin.2024.12.010

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