Infections caused by extended-spectrum β-lactamase-producing Enterobacterales after rectal colonization with ESBL-producing Escherichia coli or Klebsiella pneumoniae

Autor: Friederike Maechler, Frank J. Schwab, Anna Weber, Luisa A. Denkel, Axel Kola, Michael Pietsch, Guido Werner, Susanne Weber, Yvonne Pfeifer, Frieder Pfäfflin, Petra Gastmeier, Rasmus Leistner
Rok vydání: 2020
Předmět:
Adult
Male
0301 basic medicine
Microbiology (medical)
medicine.medical_specialty
Klebsiella pneumoniae
030106 microbiology
medicine.disease_cause
beta-Lactamases
03 medical and health sciences
0302 clinical medicine
Internal medicine
Drug Resistance
Bacterial
Escherichia coli
polycyclic compounds
medicine
Pulsed-field gel electrophoresis
Humans
Colonization
Prospective Studies
030212 general & internal medicine
Risk factor
Prospective cohort study
Escherichia coli Infections
Aged
Cross Infection
Whole Genome Sequencing
biology
business.industry
Incidence
Incidence (epidemiology)
Rectum
General Medicine
Middle Aged
biochemical phenomena
metabolism
and nutrition
bacterial infections and mycoses
biology.organism_classification
Confidence interval
Electrophoresis
Gel
Pulsed-Field
Klebsiella Infections
Infectious Diseases
bacteria
Female
business
Genome
Bacterial
Zdroj: Clinical Microbiology and Infection. 26:1046-1051
ISSN: 1198-743X
DOI: 10.1016/j.cmi.2019.11.025
Popis: Objectives Infections as a result of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) are considered infections with a high public health burden. In this study, we aimed to identify incidences of and risk factors for healthcare-associated infections (HAIs) after rectal colonization with ESBL-producing Escherichia coli (ESBL-EC) or Klebsiella pneumoniae (ESBL-KP). Methods This prospective cohort study was performed in 2014 and 2015. Patients colonized with ESBL-EC or ESBL-KP were monitored for subsequent HAI with ESBL-E and other pathogens. In the case of an ESBL-E infection, rectal and clinical isolates were compared using pulsed-field gel electrophoresis (PFGE), and whole-genome sequencing (WGS) for ESBL-KP isolates. Proportional hazard models were applied to identify risk factors for HAIs, and to analyse competing risks. Results Among all patients admitted to the hospital during the study period, 13.6% were rectally screened for third-generation cephalosporin-resistant Enterobacterales (3GCREB). A total of 2386 rectal carriers of ESBL-EC and 585 of ESBL-KP were included in the study. Incidence density (ID) for HAI with ESBL-E was 2.74 per 1000 patient days at risk (95% confidence interval (CI) 2.16–3.43) among carriers of ESBL-EC, while it was 4.44 per 1000 patient days at risk (95% CI 3.17–6.04) among carriers of ESBL-KP. In contrast, ID for HAI with other pathogens was 4.36 per 1000 patient days at risk (95% CI 3.62–5.21) among carriers of ESBL-EC, and 5.00 per 1000 patient days at risk (95% CI 3.64–6.69) among carriers of ESBL-KP. Cox proportional hazard regression analyses identified colonization with ESBL-KP (HR = 1.58, 95% CI 1.068–2.325) compared with ESBL-EC as independent risk factor for HAI with ESBL-E. The results were consistent over all competing risk analyses. Conclusions Clinicians should be aware of the increased risk of ESBL-E infections among patients colonized with ESBL-KP compared with ESBL-EC that might be caused by underlying diseases, higher pathogenicity of ESBL-KP and other factors.
Databáze: OpenAIRE
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