Epidemiology of ESBL-producing Escherichia coli from repeated prevalence studies over 11 years in a long-term-care facility

• Published in: Antimicrobial resistance & infection control 2021-10, Vol.10 (1), p.148-148, Article 148
• Main Authors: Martischang, Romain, François, Patrice, Cherkaoui, Abdessalam, Gaïa, Nadia, Renzi, Gesuele, Agostinho, Americo, Perez, Monica, Graf, Christophe E, Harbarth, Stephan
• Format: Article
• Language: English
• Subjects: Antibiotics; Antimicrobial agents; Antimicrobial resistance; Beta lactamases; beta-Lactamases - metabolism; Carrier State - epidemiology; Carrier State - microbiology; Cloning; Cross-Sectional Studies; Disease control; Disease Reservoirs - microbiology; Drug resistance; Drug resistance in microorganisms; Drug Resistance, Multiple; E coli; Epidemiology; Escherichia coli; Escherichia coli - classification; Escherichia coli - enzymology; Escherichia coli - genetics; Escherichia coli Infections - epidemiology; Escherichia coli Infections - microbiology; Escherichia coli Infections - prevention & control; Feces - microbiology; Fluoroquinolone resistance; Genes; Genomes; Humans; Hygiene; Infections; Length of stay; Long term health care; Long-Term Care; Long-term care facilities; Long-term care of the sick; Molecular epidemiology; Outbreaks; PCR; Prevalence; Prevalence studies (Epidemiology); Rectum - microbiology; ST131; Universal Precautions
• ISSN: 2047-2994; 2047-2994
• DOI: 10.1186/s13756-021-01013-7

Escherichia coli sequence type (ST) 131 H30 is an emerging multidrug resistant subclone, known to spread and cause outbreaks in long-term care facilities (LTCFs). From 2010 through 2020, we performed 11 yearly surveillance studies for determining the prevalence of digestive carriage of ESBL-producing E. coli (ESBL-EC) among residents in a university-affiliated LCTF. Sequencing and genotyping of selected isolates were performed to characterize temporal trends in the prevalence and epidemic potential of ESBL-EC subclones, and for evaluating a potential rebound effect following discontinuation of contact precautions for ESBL-EC carriers in January 2019. This study included 2'403 LTCF residents, with 252 (10.5%) positive for ESBL-EC. Among the 236 ESBL-EC isolates available for typing, 58.0% belonged to the ST131 lineage, including 94/137 (68.6%) ST131 H30 isolates. An increasing yearly prevalence was observed for ESBL-EC (from 4.6 to 9.4%; p = 0.11), but not for the ST131 H30 subclone, which peaked in 2015 and declined thereafter. Multiple previously unnoticed ESBL-EC outbreaks occurred in the LTCF. Since 2018, we noted the clonal expansion of a rare ST131 H89 subclone (O16:H5) harboring CTX-M-14 and CTX-M-24. No rebound effect was observed in ESBL-EC prevalence nor in the different subclones following discontinuation of contact precautions for ESBL-EC carriers since 2019. Clonal fluctuation was observed for ST131 H30 ESBL-EC with a current decline in prevalence. Surveillance should include the evolution of ST131 non-H30 subclones, which may spread in LTCFs. Our findings suggest that discontinuation of contact precautions for ESBL-EC carriers in LTCFs may be safely implemented, in support of European recommendations to limit ESBL-producing Enterobacteriaceae control measures in endemic settings to non-E. coli.