Colonization with third-generation cephalosporin-resistant Enterobacteriaceae on hospital admission: prevalence and risk factors

Abstract Objectives To characterize putative AmpC-hyperproducing third-generation cephalosporin-resistant E. coli from dairy farms and their phylogenetic relationships; to identify risk factors for their presence; and to assess evidence for their zoonotic transmission into the local human population. Methods Proteomics was used to explain differences in antimicrobial susceptibility. WGS allowed phylogenetic analysis. Multilevel, multivariable logistic regression modelling was used to identify risk factors. Results Increased use of amoxicillin/clavulanate was associated with an increased risk of finding AmpC hyperproducers on farms. Expansion of cephalosporin resistance in AmpC hyperproducers was seen in farm isolates with marR mutations (conferring cefoperazone resistance) or when AmpC was mutated (conferring fourth-generation cephalosporin and cefoperazone resistance). Phylogenetic analysis confirmed the dominance of ST88 amongst farm AmpC hyperproducers but there was no evidence for acquisition of farm isolates by members of the local human population. Conclusions Clear evidence was found for recent farm-to-farm transmission of AmpC-hyperproducing E. coli and of adaptive mutations to expand resistance. Whilst there was no evidence of isolates entering the local human population, efforts to reduce third-generation cephalosporin resistance on dairy farms must address the high prevalence of AmpC hyperproducers. The finding that amoxicillin/clavulanate use was associated with an increased risk of finding AmpC hyperproducers is important because this is not currently categorized as a highest-priority critically important antimicrobial and so is not currently targeted for specific usage restrictions in the UK.

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Risk Factors for Emergence of Resistance to Broad-Spectrum Cephalosporins among Enterobacterspp

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.45.9.2628-2630.2001 ◽

2001 ◽

Vol 45 (9) ◽

pp. 2628-2630 ◽

Cited By ~ 104

Author(s):

Keith S. Kaye ◽

Sara Cosgrove ◽

Anthony Harris ◽

George M. Eliopoulos ◽

Yehuda Carmeli

Keyword(s):

Risk Factors ◽

Relative Risk ◽

Broad Spectrum ◽

Generation Cephalosporin ◽

Third Generation ◽

Independent Risk Factors ◽

Emergence Of Resistance

ABSTRACT Among 477 patients with susceptible Enterobacter spp., 49 subsequently harbored third-generation cephalosporin-resistantEnterobacter spp. Broad-spectrum cephalosporins were independent risk factors for resistance (relative risk [OR] = 2.3, P = 0.01); quinolone therapy was protective (OR = 0.4, P = 0.03). There were trends toward decreased risk for resistance among patients receiving broad-spectrum cephalosporins and either aminoglycosides or imipenem. Of the patients receiving broad-spectrum cephalosporins, 19% developed resistance.

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Clinical Impact and Risk Factors of Nonsusceptibility to Third-Generation Cephalosporins Among Hospitalized Adults With Monomicrobial Enterobacteriaceae Bacteremia in Southern Taiwan: A Multicenter Study

10.21203/rs.3.rs-100053/v1 ◽

2020 ◽

Author(s):

Tsao-Chin Lin ◽

Yuan-Pin Hung ◽

Ching-Chi Lee ◽

Wei-Tang Lin ◽

Li-Chen Huang ◽

...

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Generation Cephalosporin ◽

Rapid Identification ◽

First Episode ◽

Prognostic Impact ◽

Third Generation ◽

Crude Mortality ◽

District Hospitals ◽

Southern Taiwan

Abstract Background: Reducing effectiveness of broad-spectrum cephalosporins against Enterobacteriaceae infections has been recognized. This study aimed to investigate risk factors and clinical significance of third-generation cephalosporin nonsusceptibility (3GC-NS) among the cases of monomicrobial Enterobacteriaceae bacteremia (mEB) at regional or district hospitals.Methods: The study was conducted at three hospitals at southern Taiwan between Jan. 2017 and Oct. 2019. Only the first episode of mEB from each adult (aged ≥20 years) was included. The primary outcome was in-hospital crude mortality.Results: Overall there were 499 episodes of adults with mEB included, and their mean age was 74.5 years. Female predominated, accounting for 53% of all patients. Escherichia coli (62%) and Klebsiella pneumoniae (21%) were two major causative species. The overall mortality rate was 15% (73/499), and patients infected by 3GC-NS isolates (34%, 172/499) had a higher mortality rate than those by 3GC-susceptible isolates (66%, 327/499) (21% vs. 11%, P=0.005). By the multivariate analysis, 3GC-NS was the only independent prognostic determinant (adjusted odds ratio [AOR], 1.78; P=0.04). Of note, male (AOR 2.02, P=0.001), nosocomial-acquired bacteremia (AOR 2.77, P<0.001), and usage of nasogastric tube (AOR 2.01, P=0.002) were positively associated with 3GC-NS, but P. mirabilis bacteremia (AOR 0.28, P=0.01) and age (AOR 0.98, P=0.04) negatively with 3GC-NS.Conclusion: For adults with Enterobacteriaceae bacteremia, 3GC-NS signifies a significant prognostic impact. Efforts to rapid identification of such antimicrobial resistance profiles should be incorporated into antimicrobial stewardship programs to achieve favorable outcomes.

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Extended-spectrum beta-lactamase-producing Enterobacteriaceae carriage upon hospital admission: prevalence and risk factors

Journal of Hospital Infection ◽

10.1016/j.jhin.2013.07.014 ◽

2013 ◽

Vol 85 (3) ◽

pp. 230-232 ◽

Cited By ~ 21

Author(s):

P. Shitrit ◽

S. Reisfeld ◽

Y. Paitan ◽

B-S. Gottesman ◽

M. Katzir ◽

...

Keyword(s):

Risk Factors ◽

Hospital Admission ◽

Beta Lactamase ◽

Extended Spectrum Beta Lactamase ◽

Extended Spectrum ◽

Admission Prevalence

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Prevalence of third-generation cephalosporin-resistant Enterobacterales colonization on hospital admission and ESBL genotype-specific risk factors: a cross-sectional study in six German university hospitals

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkaa052 ◽

2020 ◽

Vol 75 (6) ◽

pp. 1631-1638

Author(s):

Anna M Rohde ◽

Janine Zweigner ◽

Miriam Wiese-Posselt ◽

Frank Schwab ◽

Michael Behnke ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Hospital Stay ◽

Generation Cephalosporin ◽

Resistant Bacteria ◽

Third Generation ◽

University Hospitals ◽

Term Care ◽

Specific Risk ◽

M 14

Abstract Objectives To assess the admission prevalence of third-generation cephalosporin-resistant Enterobacterales (3GCREB) and to assess whether risk factors vary by β-lactamase genotype. Methods Adult patients were recruited within 72 h of admission to general wards of six university hospitals in 2014 and 2015. Rectal swabs were screened for 3GCREB and isolates were analysed phenotypically and genotypically. Patients were questioned on potential risk factors. Multivariable analyses were performed to identify risk factors for 3GCREB colonization and for specific β-lactamases. Results Of 8753 patients screened, 828 were 3GCREB positive (9.5%). Eight hundred and thirteen isolates were available for genotyping. CTX-M-15 was the most common ESBL (38.0%), followed by CTX-M-1 (22.5%), CTX-M-14 (8.7%), CTX-M-27 (7.5%) and SHV-ESBL (4.4%). AmpC was found in 11.9%. Interestingly, 18 Escherichia coli isolates were AmpC positive, 12 of which (67%) contained AmpC on a gene of plasmid origin [CMY (n = 10), DHA (n = 2)]. Risk factors for 3GCREB colonization varied by genotype. Recent antibiotic exposure and prior colonization by antibiotic-resistant bacteria were risk factors for all β-lactamases except CTX-M-14 and CTX-M-27. Travel outside Europe was a risk factor for CTX-M-15 and CTX-M-27 [adjusted OR (aOR) 3.49, 95% CI 2.88–4.24 and aOR 2.73, 95% CI 1.68–4.43]. A previous stay in a long-term care facility was associated with CTX-M-14 (aOR 3.01, 95% CI 1.98–4.59). A preceding hospital stay in Germany increased the risk of CTX-M-15 (aOR 1.27, 95% CI 1.14–1.41), while a prior hospital stay in other European countries increased the risk of SHV-ESBL colonization (aOR 3.85, 95% CI 1.67–8.92). Conclusions The detection of different ESBL types is associated with specific risk factor sets that might represent distinct sources of colonization and ESBL-specific dissemination routes.

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