Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, The Netherlands.
Clin Infect Dis. 2018 Apr 17;66(9):1368-1376. doi: 10.1093/cid/cix1015.
This longitudinal study aimed to investigate (risk factors for) persistence of carriage and molecular characteristics of extended-spectrum and plasmid-encoded AmpC β-lactamase-producing (ESBL/pAmpC) Escherichia coli and Klebsiella pneumoniae (ESBL-E/K) in adults in the Dutch community.
Following a cross-sectional study (ESBL-E/K prevalence, 4.5%), a subset of ESBL-E/K-positive (n = 76) and -negative (n = 249) individuals volunteered to provide 5 monthly fecal samples and questionnaires. ESBL-E/K was cultured using selective enrichment/culture, and multilocus sequence types (MLSTs) were determined. ESBL/pAmpC-genes were analyzed using polymerase chain reaction (PCR) and sequencing. Plasmids were characterized and subtyped by plasmid MLST. Risk factors for persistent carriage were analyzed using logistic regression.
Of the initially ESBL-E/K-positive participants, 25 of 76 (32.9%) remained positive in all subsequent samples; 51 of 76 persons (67.1%) tested ESBL-E/K negative at some time point during follow-up, of which 31 (40.8%) stayed negative throughout the longitudinal study. Carriers often carried the same ESBL gene and plasmid, but sometimes in different ESBL-E/K strains, indicative for horizontal transfer of plasmids. Of the 249 initially ESBL-E/K-negative participants, the majority (n = 218 [87.6%]) tested negative during 8 months of follow-up, whereas 31 of 249 (12.4%) participants acquired an ESBL-E/K. Escherichia coli phylogenetic group B2 and D and travel to ESBL high-prevalence countries were associated with prolonged carriage.
ESBL-E/K carriage persisted for >8 months in 32.9% of the initially ESBL-positive individuals, while 12.4% of initially negative individuals acquired ESBL-E/K during the study. A single positive test result provides no accurate prediction for prolonged carriage. Acquisition/loss of ESBL-E/K does not seem to be a random process, but differs between bacterial genotypes.
本纵向研究旨在调查（风险因素）在荷兰社区成年人中，产超广谱和质粒编码 AmpCβ-内酰胺酶（ESBL/pAmpC）大肠埃希菌和肺炎克雷伯菌（ESBL-E/K）的持续携带和分子特征。
在横断面研究（ESBL-E/K 流行率为 4.5%）之后，ESBL-E/K 阳性（n=76）和阴性（n=249）个体的一部分自愿提供 5 份每月粪便样本和调查问卷。使用选择性富集/培养培养 ESBL-E/K，确定多位点序列类型（MLST）。使用聚合酶链反应（PCR）和测序分析 ESBL/pAmpC 基因。通过质粒 MLST 对质粒进行特征分析和亚型分析。使用逻辑回归分析持续性携带的危险因素。
最初 ESBL-E/K 阳性的参与者中，76 人中有 25 人（32.9%）在所有后续样本中均为阳性；76 人中有 51 人（67.1%）在随访期间的某个时间点检测为 ESBL-E/K 阴性，其中 31 人（40.8%）在整个纵向研究中保持阴性。携带菌经常携带相同的 ESBL 基因和质粒，但有时在不同的 ESBL-E/K 菌株中，表明质粒发生了水平转移。在最初 249 名 ESBL-E/K 阴性的参与者中，大多数（n=218[87.6%]）在 8 个月的随访期间检测为阴性，而 249 名参与者中有 31 名（12.4%）获得了 ESBL-E/K。大肠杆菌进化群 B2 和 D 以及前往 ESBL 高流行国家与持续携带有关。
在最初 ESBL 阳性的个体中，有 32.9%的个体持续携带 ESBL-E/K 超过 8 个月，而在最初 ESBL 阴性的个体中，有 12.4%的个体在研究期间获得了 ESBL-E/K。单次阳性检测结果无法准确预测持续携带。ESBL-E/K 的获得/丢失似乎不是一个随机过程，而是因细菌基因型而异。
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