Göpel S, Guther J, Gladstone B P, Conzelmann N, Bunk S, Terzer T, Verschuuren T D, Martak D, Rivera E Salamanca, Autenrieth I B, Peter S, Kluytmans J A J W, Hocquet D, Rodriguez-Baño J, Tacconelli E
Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany; DZIF-Clinical Research Unit, Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany.
Institute of Medical Microbiology and Hygiene, University Hospital Tübingen, Tübingen, Germany.
J Hosp Infect. 2025 Mar;157:67-74. doi: 10.1016/j.jhin.2024.12.010. Epub 2025 Jan 7.
Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBL-PE) are highly prevalent in long-term care (LTCF) settings. In order to estimate the acquisition rate of ESBL-producing Escherichia coli and Klebsiella pneumoniae in LTCF settings, and identify clinical and environmental risk factors, a multi-centre, prospective cohort study was conducted in six LTCFs in Germany, France, Spain and the Netherlands.
Longitudinal screening of residents was performed over 32 weeks, collecting epidemiological and clinical data and environmental samples. The primary outcome was the rate of new acquisition of ESBL-PE among LTCF residents. Molecular epidemiology was studied using whole genome sequencing, and risk factor analysis was undertaken using logistic and Poisson regression models.
In total, 299 residents provided 1958 samples during follow-up. The prevalence of ESBL-PE colonization at baseline was 16.4%, and the incidence of acquisition was 0.79 per 1000 resident-days, both with high variability between LTCFs. Age ≥80 years, vascular disease and antibiotic consumption within the preceding year were risk factors for baseline colonization. Lack of hand sanitizers and a low nurse:resident ratio were associated with colonization. The presence of medical devices was associated with risk of acquisition. Vascular disease, hemiplegia, antibiotic consumption, and non-availability of private bathrooms were associated with carriage of multiple sequence types (STs). The prevalence of ESBL-PE among environmental samples was 2%, exclusively in LTCFs with high prevalence among residents. Genetic analysis showed a high prevalence of ST10 E. coli and ST405 K. pneumoniae at two study sites.
Infection prevention interventions, including availability of hand sanitizers, the number of nurses per resident, and antimicrobial stewardship, constitute important measures to control ESBL-PE in LTCFs. Genome-based surveillance could guide targeted interventions.
产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌（ESBL-PE）在长期护理机构（LTCF）中高度流行。为了估计长期护理机构中产ESBL的大肠杆菌和肺炎克雷伯菌的获得率，并确定临床和环境危险因素，在德国、法国、西班牙和荷兰的6家长期护理机构中进行了一项多中心前瞻性队列研究。
对居民进行了32周的纵向筛查，收集流行病学和临床数据以及环境样本。主要结局是长期护理机构居民中新获得ESBL-PE的发生率。使用全基因组测序研究分子流行病学，并使用逻辑回归和泊松回归模型进行危险因素分析。
在随访期间，共有299名居民提供了1958份样本。基线时ESBL-PE定植的患病率为16.4%，获得率为每1000居民日0.79例，两家长期护理机构之间的差异均很大。年龄≥80岁、血管疾病和前一年使用抗生素是基线定植的危险因素。缺乏洗手液和护士与居民比例低与定植有关。医疗器械的存在与获得风险有关。血管疾病、偏瘫、抗生素使用以及没有私人浴室与携带多种序列类型（ST）有关。环境样本中ESBL-PE的患病率为2%，仅在居民患病率高的长期护理机构中出现。基因分析显示，在两个研究地点，ST10大肠杆菌和ST405肺炎克雷伯菌的患病率很高。
感染预防干预措施，包括提供洗手液、每名居民的护士数量以及抗菌药物管理，是控制长期护理机构中ESBL-PE的重要措施。基于基因组的监测可以指导有针对性的干预措施。
