Department of Infection Control, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands.
Microvida Laboratory for Microbiology, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands.
Antimicrob Resist Infect Control. 2022 Jul 15;11(1):98. doi: 10.1186/s13756-022-01132-9.
In 2016, a study in a Dutch nursing home showed prolonged colonization duration of extended-spectrum β-lactamase-producing (ESBL)-ST131 compared to ESBL-non-ST131. In this study, we assessed the duration of rectal ESBL-producing E. coli (ESBL-EC) colonization in residents in the same nursing home for an extended period of six years. We aimed to estimate the influence of a possible bias when follow up is started during an outbreak.
Between 2013 and 2019, repetitive point prevalence surveys were performed by culturing rectal or faecal swabs from all residents. Kaplan-Meier survival analysis was performed to calculate the median time to clearance of ESBL-EC with a log-rank analysis to test for differences between ESBL-ST131 and ESBL-non-ST131.
The study showed a median time to clearance of 13.0 months (95% CI 0.0-27.9) for ESBL-ST131 compared to 11.2 months (95% CI 4.8-17.6) for ESBL-non-ST131 (p = 0.044). In the subgroup analysis of residents who were ESBL-EC positive in their first survey, the median time to clearance for ST131 was 59.7 months (95% CI 23.7-95.6) compared to 16.2 months (95% CI 2.1-30.4) for ESBL-non-ST131 (p = 0.036). In the subgroup analysis of residents who acquired ESBL-EC, the median time to clearance for ST131 was 7.2 months (95% CI 2.1-12.2) compared to 7.9 months (95% CI 0.0-18.3) for ESBL-non-ST131 (p = 0.718). The median time to clearance in the ESBL-ST131 group was significantly longer in residents who were ESBL-ST131 colonised upon entering the study than in residents who acquired ESBL-ST131 during the study (p = 0.001).
A prolonged colonization with ESBL-ST131 was only found in the subgroup who was ESBL-EC positive upon entering the study. The prolonged duration with ESBL-ST131 in the previous study was probably biased by factors that occured during (the start of) the outbreak.
2016 年，荷兰一家疗养院的一项研究表明，与非 ST131 型 ESBL 相比，产 ESBL-ST131 的时间更长。在这项研究中，我们评估了同一疗养院居民的直肠产 ESBL 大肠埃希菌（ESBL-EC）定植时间延长至六年。我们旨在估计当在暴发期间开始随访时可能存在的偏倚的影响。
2013 年至 2019 年，对所有居民进行直肠或粪便拭子重复点患病率调查。采用 Kaplan-Meier 生存分析计算 ESBL-EC 清除的中位时间，对数秩检验检验 ESBL-ST131 与 ESBL-非 ST131 之间的差异。
研究显示，ESBL-ST131 的中位清除时间为 13.0 个月（95%CI0.0-27.9），而 ESBL-非 ST131 的中位清除时间为 11.2 个月（95%CI4.8-17.6）（p=0.044）。在首次调查中 ESBL-EC 阳性的居民亚组分析中，ST131 的中位清除时间为 59.7 个月（95%CI23.7-95.6），而非 ST131 的中位清除时间为 16.2 个月（95%CI2.1-30.4）（p=0.036）。在获得 ESBL-EC 的居民亚组分析中，ST131 的中位清除时间为 7.2 个月（95%CI2.1-12.2），而非 ST131 的中位清除时间为 7.9 个月（95%CI0.0-18.3）（p=0.718）。在进入研究时即定植 ESBL-ST131 的居民中，ST131 组的中位清除时间明显长于在研究期间获得 ESBL-ST131 的居民（p=0.001）。
仅在进入研究时 ESBL-EC 阳性的亚组中发现 ESBL-ST131 定植时间延长。之前研究中 ESBL-ST131 持续时间延长可能是由于暴发期间（开始时）发生的因素所致。
