Prevalence and risk factors for carriage of ESBL-producing Enterobacteriaceae in Amsterdam
Journal of Antimicrobial Chemotherapy April 2016 V.71 N.4 P.1076-1082
A. Reuland, N. al Naiemi, A. M. Kaiser, M. Heck, J. A. J. W. Kluytmans, P. H. M. Savelkoul, P. J. M. Elders, and C. M. J. E. Vandenbroucke-Grauls
1Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
2Laboratory for Medical Microbiology and Public Health, Hengelo, The Netherlands
3Medical Microbiology and Infection Control, Ziekenhuisgroep Twente, Almelo, The Netherlands
4Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
5Department of Medical Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands
6Department of Medical Microbiology, St Elisabeth Hospital, Tilburg, The Netherlands
7EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
The objectives of this study were to determine the prevalence of carriage of ESBL-producing Enterobacteriaceae (ESBL-E) in a representative sample of the general adult Dutch community, to identify risk factors and to gain understanding of the epidemiology of these resistant strains.
Adults enrolled in five general practices in Amsterdam were approached by postal mail and asked to fill in a questionnaire and to collect a faecal sample. Samples were analysed for the presence of ESBL-E. ESBL genes were characterized by PCR and sequencing. Strains were typed using MLST and amplified fragment length polymorphism (AFLP) and plasmids were identified by PCR-based replicon typing. Risk factors for carriage were investigated by multivariate analysis.
ESBL-E were found in 145/1695 (8.6%) samples; 91% were Escherichia coli. Most ESBL genes were of the CTX-M group (blaCTX-M-1 and blaCTX-M-15). MLST ST131 was predominant and mainly associated with CTX-M-15-producing E. coli. One isolate with reduced susceptibility to ertapenem produced OXA-48. In multivariate analyses, use of antimicrobial agents, use of antacids and travel to Africa, Asia and Northern America were associated with carriage of ESBL-E, in particular strains with blaCTX-M-14/15.
This study showed a high prevalence of ESBL-E carriage in the general Dutch community. Also, outside hospitals, the use of antibiotics was a risk factor; interestingly, use of antacids increased the risk of carriage. A major risk factor in the general population was travel to countries outside Europe, in particular to Asia, Africa and Northern America.