Hidad S, Greeff S C de, Haan F de, Schilperoort R, Leusink G L, Timen A, Schmitt H
Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.
PLoS One. 2025 May 15;20(5):e0324083. doi: 10.1371/journal.pone.0324083. eCollection 2025.
Antimicrobial resistance (AMR) has become one of the leading global health threats. It is critical to understand the burden of AMR, particularly among vulnerable populations such as people with intellectual disabilities residing in long-term care facilities (ID-LTCFs). Traditional study methods to estimate the burden of AMR in these settings, such as rectal swabs to measure the prevalence of MDRO carriage, are considered burdensome for this population. This underscores the importance of a non-invasive method to assess the burden of AMR among people living in ID-LTCFs. This publication describes a study protocol for an alternative approach to estimate AMR, specifically Extended Spectrum Beta-Lactamase (ESBL) and carbapenemase-producing Enterobacterales (CPE), in ID-LTCFs in the Netherlands, through wastewater measurements combined with analysis of stool collected from diaper material. The protocol provides detailed information about the study design and methodologies proposed for a pilot study.
Wastewater samples will be obtained from the sewers of ID-LCTFs using passive samplers. Additionally, as a considerable part of ID-LTCF residents are incontinent, stool samples will be collected from diaper material which will be obtained from incontinent residents living in participating ID-LTCFs. The wastewater and stool samples will be cultured on selective media to detect ESBL-producing Enterobacterales and carbapenem producing Enterobacterales (CPE) strains. Determination of strains will be carried out using MALDI-TOF and phenotypical tests will be carried out to confirm ESBL and CPE producing strains. In wastewater samples, bacterial concentrations will be determined, expressed in colony forming unit (CFU) per passive sampler, while in stool from diaper material the presence or absence of ESBL and CPE will be reported in proportions.
The procedures described in this study protocol will be conducted in line with principles outlined in the Declaration of Helsinki, Code of Conduct for Health research, as well as the General Data Protection Regulation. Approval in advance by an ethical research committee or institutional review board is deemed unnecessary by current national and European legislation.
抗菌药物耐药性(AMR)已成为全球主要的健康威胁之一。了解AMR的负担至关重要,尤其是在长期护理机构(ID-LTCFs)中居住的智障人群等弱势群体中。在这些环境中,传统的估计AMR负担的研究方法,如通过直肠拭子来测量多重耐药菌(MDRO)携带率,被认为对该人群来说负担过重。这凸显了采用非侵入性方法评估ID-LTCFs居民中AMR负担的重要性。本出版物描述了一种替代方法的研究方案,该方法通过废水测量并结合对从尿布材料中收集的粪便进行分析,来估计荷兰ID-LTCFs中AMR的情况,特别是超广谱β-内酰胺酶(ESBL)和产碳青霉烯酶肠杆菌科细菌(CPE)。该方案提供了关于一项试点研究的研究设计和拟采用方法的详细信息。
将使用被动采样器从ID-LCTFs的下水道中获取废水样本。此外,由于ID-LTCF的相当一部分居民大小便失禁,将从尿布材料中收集粪便样本,这些尿布材料将从参与研究的ID-LTCFs中大小便失禁的居民那里获取。废水和粪便样本将在选择性培养基上培养,以检测产ESBL肠杆菌科细菌和产碳青霉烯酶肠杆菌科细菌(CPE)菌株。将使用基质辅助激光解吸电离飞行时间质谱(MALDI-TOF)进行菌株鉴定,并将进行表型测试以确认产ESBL和CPE的菌株。在废水样本中,将确定细菌浓度,以每个被动采样器中的菌落形成单位(CFU)表示,而在尿布材料中的粪便中,将按比例报告ESBL和CPE的存在与否。
本研究方案中描述的程序将按照《赫尔辛基宣言》、健康研究行为准则以及《通用数据保护条例》中概述的原则进行。根据现行国家和欧洲立法,无需事先获得伦理研究委员会或机构审查委员会的批准。