Antimicrobial resistance and infection control · 2025
Intestinal colonisation with extended-spectrum beta-lactamase-producing Enterobacterales and the impact of selected factors on intestinal colonisation duration: a prospective cohort study.
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Drinković Dragana, Holland David, Zhou Lifeng, Taylor Susan, Bhally Hasan, Upton Arlo, Beatson Scott, Briggs Simon
Аннотация
INTRODUCTION: We conducted a prospective cohort study of patients with newly acquired extended-spectrum beta-lactamase-producing Enterobacterales (ESBLPE) intestinal colonisation (termed "ESBLPE colonisation") in two public hospitals between January 2013 and October 2016. We evaluated the duration of ESBLPE colonisation and the impact of selected factors on this duration.
METHODS: Patient data and faeces samples were collected on enrolment and three monthly for 2 years. Standard laboratory methods were used for ESBLPE identification and susceptibility testing. Whole-genome sequencing of isolates was performed determining sequence type, plasmid replicons, antimicrobial resistance genes, virulence factor genes and phylogenetic relationships.
RESULTS: The median duration of ESBLPE colonisation for the 102 patients was 544 days (range 77-730 days, interquartile range 220-730 days). After one year and at the end of follow up, 61% and 23.4% of patients respectively remained ESBLPE colonised. The same strain of ESBLPE, colonised 70.2% (33/47) patients colonised with Escherichia coli and 70.7% (29/42) patients colonised with Klebsiella pneumoniae. Prolonged ESBLPE colonisation was associated with age ≥ 75 years (HR 0.46, 95% CI 0.23-0.90), an increased intensity of hospitalisation (P = 0.0036), E. coli phylogroup B2 (P = 0.0142), E. coli harbouring blaCTX-M-15 (P < 0.0001), colonisation with more than one species of ESBLPE (P = 0.0023) and colonisation with more than one E. coli Sequence Type (P = 0.0042).
CONCLUSIONS: It is likely that combinations of multiple patient and bacterial factors influence the duration of ESBLPE colonisation. This prolonged duration of ESBLPE colonisation highlights the importance of infection control and public health measures to decrease the acquisition and spread of ESBLPE.
METHODS: Patient data and faeces samples were collected on enrolment and three monthly for 2 years. Standard laboratory methods were used for ESBLPE identification and susceptibility testing. Whole-genome sequencing of isolates was performed determining sequence type, plasmid replicons, antimicrobial resistance genes, virulence factor genes and phylogenetic relationships.
RESULTS: The median duration of ESBLPE colonisation for the 102 patients was 544 days (range 77-730 days, interquartile range 220-730 days). After one year and at the end of follow up, 61% and 23.4% of patients respectively remained ESBLPE colonised. The same strain of ESBLPE, colonised 70.2% (33/47) patients colonised with Escherichia coli and 70.7% (29/42) patients colonised with Klebsiella pneumoniae. Prolonged ESBLPE colonisation was associated with age ≥ 75 years (HR 0.46, 95% CI 0.23-0.90), an increased intensity of hospitalisation (P = 0.0036), E. coli phylogroup B2 (P = 0.0142), E. coli harbouring blaCTX-M-15 (P < 0.0001), colonisation with more than one species of ESBLPE (P = 0.0023) and colonisation with more than one E. coli Sequence Type (P = 0.0042).
CONCLUSIONS: It is likely that combinations of multiple patient and bacterial factors influence the duration of ESBLPE colonisation. This prolonged duration of ESBLPE colonisation highlights the importance of infection control and public health measures to decrease the acquisition and spread of ESBLPE.