Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
Antimicrobial Resistance & Infection Control
Published in: Antimicrobial Resistance & Infection Control 1/2018

Open Access 01-12-2018 | Research

Travel to Asia is a strong predictor for carriage of cephalosporin resistant E. coli and Klebsiella spp. but does not explain everything; prevalence study at a Norwegian hospital 2014–2016

Authors: Laura Espenhain, Silje Bakken Jørgensen, Truls Michael Leegaard, Michaela Marie Lelek, Siri Haug Hänsgen, Britt Nakstad, Marianne Sunde, Martin Steinbakk

Published in: Antimicrobial Resistance & Infection Control | Issue 1/2018

Login to get access

Abstract

Background

We aimed to estimate the prevalence of faecal carriage of extended-spectrum cephalosporin (ESC) resistant E. coli and K. pneumoniae (ESCr-EK) and vancomycin resistant enterococci (VRE) in patients upon hospital admission and identify factors associated with carriage to better target interventions and to guide empirical antibiotic treatment.

Methods

Between October 2014 and December 2016, we recruited patients admitted to a Norwegian university hospital. A rectal swab and questionnaire covering possible risk factors for colonisation were collected upon admission. Isolates were characterized by phenotypic methods. ESCr-EK isolates were subject to whole genome sequencing. We calculated prevalence and adjusted prevalence ratios (aPR) using binomial regression.

Results

Of 747 patients, 45 (6.0%) were colonised with ESCr-EK, none with VRE. The ESCr-EK isolates in 41 patients were multidrug resistant; no isolates were non-suceptible to meropenem. Prevalence of ESCr-EK was higher among travellers to Asia (aPR = 6.6; 95%CI 3.6–12; p < 0.001). No statistical significant difference in carriage was observed between departments, age or any other factors in the univariable analyses.

Conclusions

The observed prevalence of ESCr-EK colonisation upon admission was in the same range but lower than that reported in similar studies from Europe. Travel to Asia was a strong predictor for colonisation of ESCr-EK to be considered when administering empirical antimicrobial treatment. As less than one third of colonised patients had travelled to Asia, and no other factors investigated were found to be strongly associated with carriage, these findings underscore that healthcare personnel must apply standard infection control precautions for all patients.
Appendix
Available only for authorised users
Literature
1.
World Health Organisation. Antimicrobial resistance: global report on surveillance. World Health Organization. Geneva: WHO, 2014. ISBN 978 92 4 156474 8
2.
de Kraker ME, Jarlier V, Monen JC, Heuer OE, van de Sande N, Grundmann H. The changing epidemiology of bacteraemias in Europe: trends from the European antimicrobial resistance surveillance system. Clin Microbiol Infect. 2013;19(9):860–8.CrossRefPubMed
3.
Tacconelli E, Cataldo MA, Dancer SJ, De Angelis G, Falcone M, Frank U, et al. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant gram-negative bacteria in hospitalized patients. Clin Microbiol Infect. 2014;20(Suppl 1):1–55.CrossRefPubMed
4.
Naseer U, Natas OB, Haldorsen BC, Bue B, Grundt H, Walsh TR, et al. Nosocomial outbreak of CTX-M-15-producing E. coli in Norway. APMIS. 2007;115(2):120–6.CrossRefPubMed
5.
Jorgensen SB, Bojer MS, Boll EJ, Martin Y, Helmersen K, Skogstad M, et al. Heat-resistant, extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in endoscope-mediated outbreak. J Hosp Infect. 2016;93(1):57–62.CrossRefPubMed
6.
Tofteland S, Naseer U, Lislevand JH, Sundsfjord A, Samuelsen O. A long-term low-frequency hospital outbreak of KPC-producing Klebsiella pneumoniae involving Intergenus plasmid diffusion and a persisting environmental reservoir. PLoS One. 2013;8(3):e59015.CrossRefPubMedPubMedCentral
7.
8.
Biehl LM, Schmidt-Hieber M, Liss B, Cornely OA, Vehreschild MJ. Colonization and infection with extended spectrum beta-lactamase producing Enterobacteriaceae in high-risk patients - review of the literature from a clinical perspective. Crit Rev Microbiol. 2016;42(1):1–16.CrossRefPubMed
9.
European Center for Disease Control and Prevention. Systematic review of the effectiveness of infection control measures to prevent the transmission of extended-spectrum beta-lactamase-producing Enterobacteriaceae through cross-border transfer of patients. Stockholm: European Centre for Disease Prevention and Control; 2014.
10.
Folkehelseinstitutttet. ESBL-holdige gramnegative stavbakterier - smitteverntiltak i helseinstitusjoner2015.
11.
NORM/NORM-VET2016. Usage of Antimicrobial Agents and Occurrence of Antimicrobial Resistance in Norway. Tromsø/Oslo: NORM/NORM-VET, 2017 1890–9965.
12.
13.
Zankari E, Hasman H, Cosentino S, Vestergaard M, Rasmussen S, Lund O, et al. Identification of acquired antimicrobial resistance genes. J Antimicrob Chemother. 2012;67(11):2640–4.CrossRefPubMedPubMedCentral
14.
Larsen MV, Cosentino S, Rasmussen S, Friis C, Hasman H, Marvig RL, et al. Multilocus sequence typing of total-genome-sequenced bacteria. J Clin Microbiol. 2012;50(4):1355–61.CrossRefPubMedPubMedCentral
15.
Hamprecht A, Rohde AM, Behnke M, Feihl S, Gastmeier P, Gebhardt F, et al. Colonization with third-generation cephalosporin-resistant Enterobacteriaceae on hospital admission: prevalence and risk factors. J Antimicrob Chemother. 2016;71(10):2957–63.CrossRefPubMed
16.
Platteel TN, Leverstein-van Hall MA, Cohen Stuart JW, Thijsen SF, Mascini EM, van Hees BC, et al. Predicting carriage with extended-spectrum beta-lactamase-producing bacteria at hospital admission: a cross-sectional study. Clin Microbiol Infect. 2015;21(2):141–6.CrossRefPubMed
17.
Ben-Ami R, Schwaber MJ, Navon-Venezia S, Schwartz D, Giladi M, Chmelnitsky I, et al. Influx of extended-spectrum beta-lactamase-producing enterobacteriaceae into the hospital. Clin Infect Dis. 2006;42(7):925–34.CrossRefPubMed
18.
Ny S, Lofmark S, Borjesson S, Englund S, Ringman M, Bergstrom J, et al. Community carriage of ESBL-producing Escherichia coli is associated with strains of low pathogenicity: a Swedish nationwide study. J Antimicrob Chemother. 2017;72(2):582–8.CrossRefPubMed
19.
Ulstad CR, Solheim M, Berg S, Lindbaek M, Dahle UR, Wester AL. Carriage of ESBL/AmpC-producing or ciprofloxacin non-susceptible Escherichia coli and Klebsiella spp in healthy people in Norway. Antimicrob Resist Infect Control. 2016;5:57.CrossRefPubMedPubMedCentral
20.
Ostholm-Balkhed A, Tarnberg M, Nilsson M, Nilsson LE, Hanberger H, Hallgren A, et al. Travel-associated faecal colonization with ESBL-producing Enterobacteriaceae: incidence and risk factors. J Antimicrob Chemother [internet]. 2013;68(9):2144–53 pp.]. Available from: https://​doi.​org/​10.​1093/​jac/​dkt167.CrossRefPubMed
21.
Lausch KR, Fuursted K, Larsen CS, Storgaard M. Colonisation with multi-resistant Enterobacteriaceae in hospitalised Danish patients with a history of recent travel: a cross-sectional study. Travel Med Infect Dis. 2013;11(5):320–3.CrossRefPubMed
22.
Abrar S, Hussain S, Khan RA, Ul Ain N, Haider H, Riaz S. Prevalence of extended-spectrum-beta-lactamase-producing Enterobacteriaceae: first systematic meta-analysis report from Pakistan. Antimicrob Resist Infect Control. 2018;7:26.CrossRefPubMedPubMedCentral
23.
Boonyasiri A, Tangkoskul T, Seenama C, Saiyarin J, Tiengrim S, Thamlikitkul V. Prevalence of antibiotic resistant bacteria in healthy adults, foods, food animals, and the environment in selected areas in Thailand. Pathogens and global health. 2014;108(5):235–45.CrossRefPubMedPubMedCentral
24.
Luvsansharav UO, Hirai I, Nakata A, Imura K, Yamauchi K, Niki M, et al. Prevalence of and risk factors associated with faecal carriage of CTX-M beta-lactamase-producing Enterobacteriaceae in rural Thai communities. J Antimicrob Chemother. 2012;67(7):1769–74.CrossRefPubMed
25.
Sasaki T, Hirai I, Niki M, Nakamura T, Komalamisra C, Maipanich W, et al. High prevalence of CTX-M beta-lactamase-producing Enterobacteriaceae in stool specimens obtained from healthy individuals in Thailand. J Antimicrob Chemother. 2010;65(4):666–8.CrossRefPubMed
26.
Tekiner IH, Ozpinar H. Occurrence and characteristics of extended spectrum beta-lactamases-producing Enterobacteriaceae from foods of animal origin. Braz J Microbiol. 2016;47(2):444–51.CrossRefPubMedPubMedCentral
27.
Oteo J, Perez-Vazquez M, Campos J. Extended-spectrum [beta]-lactamase producing Escherichia coli: changing epidemiology and clinical impact. Curr Opin Infect Dis. 2010;23(4):320–6.CrossRefPubMed
28.
Ma J, Liu JH, Lv L, Zong Z, Sun Y, Zheng H, et al. Characterization of extended-spectrum beta-lactamase genes found among Escherichia coli isolates from duck and environmental samples obtained on a duck farm. Appl Environ Microbiol. 2012;78(10):3668–73.CrossRefPubMedPubMedCentral
29.
Snow LC, Warner RG, Cheney T, Wearing H, Stokes M, Harris K, et al. Risk factors associated with extended spectrum beta-lactamase Escherichia coli (CTX-M) on dairy farms in north West England and North Wales. Prev Vet Med. 2012;106(3–4):225–34.CrossRefPubMed
30.
Rodriguez-Bano J, Lopez-Cerero L, Navarro MD, Diaz de Alba P, Pascual A. Faecal carriage of extended-spectrum beta-lactamase-producing Escherichia coli: prevalence, risk factors and molecular epidemiology. J Antimicrob Chemother. 2008;62(5):1142–9.CrossRefPubMed
31.
Sheu CC, Lin SY, Chang YT, Lee CY, Chen YH, Hsueh PR. Management of infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae: current evidence and future prospects. Expert Rev Anti-Infect Ther. 2018;16(3):205–18.CrossRefPubMed
32.
Helsedirektoratet. Nasjonal faglig retningslinje for bruk av antibiotika i sykehus. In: Helsedirektoratet, editor. Oslo 2017.
33.
Healthcare Infection Control Practices Advisory Committee. Antibiotic stewardship statement for antibiotic guidelines – recommendations of the healthcare infection control practices advisory (HICPAC) committee 2016.
Metadata
Title
Travel to Asia is a strong predictor for carriage of cephalosporin resistant E. coli and Klebsiella spp. but does not explain everything; prevalence study at a Norwegian hospital 2014–2016
Authors
Laura Espenhain
Silje Bakken Jørgensen
Truls Michael Leegaard
Michaela Marie Lelek
Siri Haug Hänsgen
Britt Nakstad
Marianne Sunde
Martin Steinbakk
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Antimicrobial Resistance & Infection Control / Issue 1/2018
Electronic ISSN: 2047-2994
DOI
https://doi.org/10.1186/s13756-018-0429-7

Other articles of this Issue 1/2018

Antimicrobial Resistance & Infection Control 1/2018 Go to the issue

Letter to the Editor

Letter to the editor in response to estimating the burden of antimicrobial resistance: a systematic literature review

Letter to the Editor

Sick pets as potential reservoirs of antibiotic-resistant bacteria in Singapore

Research

Prevalence of methicillin resistant Staphylococcus aureus, multidrug resistant and extended spectrum β-lactamase producing gram negative bacilli causing wound infections at a tertiary care hospital of Nepal

Research

Antibiotic consumption and antimicrobial resistance in Poland; findings and implications

Research

Continuous increase of vancomycin resistance in enterococci causing nosocomial infections in Germany − 10 years of surveillance

Research

Attitude and perception of medical interns about antimicrobial resistance: a multi center cross-sectional study in Ethiopia

ACC 2024 Congress Coverage

Cardiology Video

Highlights from the ACC 2024 Congress

Watch now

Watch official videos from the ACC congress summarizing key highlights from the last year in heart failure, cardiomyopathies, valvular disease, pulmonary vascular disease, and pediatric cardiology.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits