Journal Article

Transmission Dynamics of Extended-Spectrum β-lactamase–Producing Enterobacteriaceae in the Tertiary Care Hospital and the Household Setting

Markus Hilty, Belinda Y. Betsch, Katja Bögli-Stuber, Nadja Heiniger, Markus Stadler, Marianne Küffer, Andreas Kronenberg, Christine Rohrer, Suzanne Aebi, Andrea Endimiani, Sara Droz and Kathrin Mühlemann

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 55, issue 7, pages 967-975
Published in print October 2012 | ISSN: 1058-4838
Published online June 2012 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1093/cid/cis581

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Background. Studies about transmission rates of extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae in hospitals and households are scarce.

Methods. Eighty-two index patients with new carriage of ESBL-producing Escherichia coli (ESBL-Ec; n = 72) or ESBL-producing Klebsiella pneumoniae (ESBL-Kp; n = 10) and their hospital (n = 112) and household (n = 96) contacts were studied prospectively from May 2008 through September 2010. Isolates were phenotypically and molecularly characterized (sequencing of bla genes, repetitive extragenic palindromic polymerase chain reaction, pulse-field gel electrophoresis, and multilocus sequence typing). Transmission was defined as carriage of a clonally-related ESBL producer with identical blaESBL gene(s) in the index patient and his or her contact(s).

Results. CTX-M-15 was the most prevalent ESBL in ESBL-Ec (58%) and ESBL-Kp (70%) in the index patients. Twenty (28%) ESBL-Ec isolates were of the hyperepidemic clone ST131. In the hospital, transmission rates were 4.5% (ESBL-Ec) and 8.3% (ESBL-Kp) and the incidences of transmissions were 5.6 (Ec) and 13.9 (Kp) per 1000 exposure days, respectively. Incidence of ESBL-Kp hospital transmission was significantly higher than that of ESBL-Ec (< .0001), despite implementation of infection control measures in 75% of ESBL-Kp index patients but only 22% of ESBL-Ec index patients. Detection of ESBL producers not linked to an index patient was as frequent (ESBL-Ec, 5.7%; ESBL-Kp, 16.7%) as nosocomial transmission events. In households, transmission rates were 23% for ESBL-Ec and 25% for ESBL-Kp.

Conclusions. Household outweighs nosocomial transmission of ESBL producers. The effect of hospital infection control measures may differ between different species and clones of ESBL producers.

Journal Article.  4701 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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