A multinational study of colonization with extended spectrum β-lactamase-producing Enterobacteriaceae in healthcare personnel and family members of carrier patients hospitalized in rehabilitation centres

A. Adler, A. Baraniak, R. Izdebski, J. Fiett, A. Salvia, J. V. Samso, C. Lawrence, J. Solomon, M. Paul, Y. Lerman, Y. Schwartzberg, E. Mordechai, A. Rossini, J. Fierro, C. Lammens, S. Malhotra-Kumar, H. Goossens, W. Hryniewicz, C. Brun-Buisson, M. GniadkowskiY. Carmeli, A. Grabowska, M. Herda, E. Nikonorow, M. J. Schwaber, E. Bilavsky, M. Elenbogen, A. Klein, S. Navon-Venezia, M. Shklyar, L. Keren, R. Glick, S. Klarfeld-Lidji, S. Cohen, R. Fachima, Y. Zdonevsky, B. Knubovets, A. Rabinovich, Wasef Naamnih, Basanda Suonov, J. Lasley, I. Bertucci, M. L. Delaby, C. Colmant, C. Sacleux, R. Formisano, M. P. Balice, E. Guaglianone, S. Camps, J. Hart, E. Isakov, A. Friedman, A. Rachman, G. Franco

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26 Scopus citations

Abstract

The study aims were: (i) to define the prevalence of and risk factors for colonization by extended spectrum β-lactamase (ESBL) -producing Enterobacteriaceae (EPE) among healthcare workers (HCWs) and family members (FMs) of EPE-colonized patients in rehabilitation units and (ii) to compare EPE isolates from these three groups. The study included 286 FMs of 194 EPE-carrying patients identified in five rehabilitation units located in Israel, Italy, France and Spain. The EPE were detected in rectal swabs from 26 (9%) of 286 FMs screened. In multivariate analyses, older age of FM, greater mean number of hours spent with the patient, being a daughter or a female spouse of a patient, and chronic lung disease of the patient were significantly associated with carriage in the FM. Escherichia coli was the most common organism (76%), followed by Klebsiella pneumoniae (19%). Isolates were typed by pulsed field gel electrophoresis and multilocus sequence typing, and ESBLs were identified by PCR sequencing. A comparison of paired species isolates from FMs and their respective patient showed that 17 of 23 strains were indistinguishable. EPE were detected in 35 (3.5%, E. coli = 34) of the 1001 HCWs screened. Feeding patients was associated with EPE carriage by HCWs. Only 7 of 23 E. coli subclones cultured from HCWs were also represented among 376 patient-derived ESBL-producing E. coli isolates from the same rehabilitation units. In Spain, a higher proportion of HCWs and FMs were ESBL carriers than elsewhere (p <0.05). In conclusion, the molecular and epidemiological data suggest that FMs are at higher risk of EPE acquisition from their relative patients than HCWs.

Original languageEnglish
Pages (from-to)O516-O523
JournalClinical Microbiology and Infection
Volume20
Issue number8
DOIs
StatePublished - Aug 2014
Externally publishedYes

Keywords

  • Carriage
  • Extended spectrum β-lactamase
  • Family members
  • Healthcare workers
  • Rehabilitation centres

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