Prevalence and risk factors for carriage of ESBL-producing Enterobacteriaceae in Amsterdam

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVES: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Original languageEnglish
Pages (from-to)1076-82
Number of pages7
JournalJournal of Antimicrobial Chemotherapy
Volume71
Issue number4
DOIs
Publication statusPublished - Apr 2016

Cite this

@article{8bcbebe954ce4ca6b8e188c710840aa3,
title = "Prevalence and risk factors for carriage of ESBL-producing Enterobacteriaceae in Amsterdam",
abstract = "OBJECTIVES: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.",
keywords = "Adolescent, Adult, Aged, Aged, 80 and over, Amplified Fragment Length Polymorphism Analysis, Carrier State, Case-Control Studies, Cross-Sectional Studies, Enterobacteriaceae, Enterobacteriaceae Infections, Female, Humans, Male, Microbial Sensitivity Tests, Middle Aged, Multilocus Sequence Typing, Netherlands, Population Surveillance, Prevalence, Risk Factors, Young Adult, beta-Lactam Resistance, beta-Lactamases, Journal Article, Research Support, Non-U.S. Gov't",
author = "Reuland, {E A} and {Al Naiemi}, N and Kaiser, {A M} and M Heck and Kluytmans, {J A J W} and Savelkoul, {P H M} and Elders, {P J M} and Vandenbroucke-Grauls, {C M J E}",
note = "{\circledC} The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.",
year = "2016",
month = "4",
doi = "10.1093/jac/dkv441",
language = "English",
volume = "71",
pages = "1076--82",
journal = "Journal of Antimicrobial Chemotherapy",
issn = "0305-7453",
publisher = "Oxford University Press",
number = "4",

}

Prevalence and risk factors for carriage of ESBL-producing Enterobacteriaceae in Amsterdam. / Reuland, E A; Al Naiemi, N; Kaiser, A M; Heck, M; Kluytmans, J A J W; Savelkoul, P H M; Elders, P J M; Vandenbroucke-Grauls, C M J E.

In: Journal of Antimicrobial Chemotherapy, Vol. 71, No. 4, 04.2016, p. 1076-82.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Prevalence and risk factors for carriage of ESBL-producing Enterobacteriaceae in Amsterdam

AU - Reuland, E A

AU - Al Naiemi, N

AU - Kaiser, A M

AU - Heck, M

AU - Kluytmans, J A J W

AU - Savelkoul, P H M

AU - Elders, P J M

AU - Vandenbroucke-Grauls, C M J E

N1 - © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.

PY - 2016/4

Y1 - 2016/4

N2 - OBJECTIVES: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.

AB - OBJECTIVES: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Amplified Fragment Length Polymorphism Analysis

KW - Carrier State

KW - Case-Control Studies

KW - Cross-Sectional Studies

KW - Enterobacteriaceae

KW - Enterobacteriaceae Infections

KW - Female

KW - Humans

KW - Male

KW - Microbial Sensitivity Tests

KW - Middle Aged

KW - Multilocus Sequence Typing

KW - Netherlands

KW - Population Surveillance

KW - Prevalence

KW - Risk Factors

KW - Young Adult

KW - beta-Lactam Resistance

KW - beta-Lactamases

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1093/jac/dkv441

DO - 10.1093/jac/dkv441

M3 - Article

VL - 71

SP - 1076

EP - 1082

JO - Journal of Antimicrobial Chemotherapy

JF - Journal of Antimicrobial Chemotherapy

SN - 0305-7453

IS - 4

ER -