Household carriage and acquisition of extended-spectrum β-lactamase–producing Enterobacteriaceae: A systematic review

Autor: Romain Martischang, Jan Kluytmans, Stéphan Juergen Harbarth, Mohamed Abbas, Maria Eugenia Riccio, Andrew J. Stewardson
Rok vydání: 2019
Předmět:
Microbiology (medical)
medicine.medical_specialty
beta-Lactamases/isolation & purification
Epidemiology
Klebsiella pneumoniae
beta-Lactamases
Enterobacteriaceae Infections/epidemiology
law.invention
03 medical and health sciences
0302 clinical medicine
Enterobacteriaceae
law
Genotype
polycyclic compounds
Escherichia coli
medicine
Humans
030212 general & internal medicine
Carrier State/epidemiology
Escherichia coli Infections
ddc:616
Family Characteristics
0303 health sciences
biology
030306 microbiology
Enterobacteriaceae Infections
biochemical phenomena
metabolism
and nutrition
bacterial infections and mycoses
biology.organism_classification
Confidence interval
Klebsiella Infections
Infectious Diseases
Transmission (mechanics)
Systematic review
Carriage
Carrier State
Carrier State/microbiology
bacteria
Demography
Cohort study
Zdroj: Infection Control and Hospital Epidemiology, Vol. 41, No 3 (2020) pp. 286-294
ISSN: 1559-6834
0899-823X
DOI: 10.1017/ice.2019.336
Popis: Objective:The epidemiology of ESBL-producing Enterobacteriaceae (ESBL-PE) has been extensively studied in hospitals, but data on community transmission are scarce. We investigated ESBL-PE cocarriage and acquisition in households using a systematic literature review.Methods:We conducted a systematic literature search to retrieve cross-sectional or cohort studies published between 1990 and 2018 evaluating cocarriage proportions and/or acquisition rates of ESBL-PE among household members, without language restriction. We excluded studies focusing on animal-to-human transmission or conducted in nonhousehold settings. The main outcomes were ESBL-PE cocarriage proportions and acquisition rates, stratified according to phenotypic or genotypic assessment of strain relatedness. Cocarriage proportions of clonally related ESBL-PE were transformed using the double-arcsine method and were pooled using a random-effects model. Potential biases were assessed manually.Results:We included 13 studies. Among 863 household members of ESBL-PE positive index cases, prevalence of ESBL-PE cocarriage ranged from 8% to 37%. Overall, 12% (95% confidence interval [CI], 8%–16%) of subjects had a clonally related strain. Those proportions were higher forKlebsiella pneumoniae(20%–25%) than forEscherichia coli(10%–20%). Acquisition rates of clonally related ESBL-PE among 180 initially ESBL-PE–free household members of a previously identified carrier ranged between 1.56 and 2.03 events per 1,000 person weeks of follow-up. We identified multiple sources of bias and high heterogeneity (I2, 70%) between studies.Conclusions:ESBL-PE household cocarriage is frequent, suggesting intrafamilial acquisition. Further research is needed to evaluate the risk and control of ESBL-PE household transmission.
Databáze: OpenAIRE
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