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Isolation and Identification of Waterborne Antibiotic-Resistant Bacteria and Molecular Characterization of their Antibiotic Resistance Genes
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Molecular Epidemiology and Risk Factors for Extended-Spectrum β-Lactamase-Producing Enterobacterales in Long-Term
Philipp Kohler1, Salome N Seiffert2, Simone Kessler1
1Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland.
Journal of the American Medical Directors Association
|July 23, 2021
Summary
Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales colonization is low in Swiss long-term care facilities, but clusters exist. Proton-pump inhibitor (PPI) use is a modifiable risk factor for ESBL carriage.
Area of Science:
- Infectious Diseases
- Microbiology
- Epidemiology
Background:
- Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales pose a significant threat in healthcare settings.
- Long-term care facilities (LTCFs) are vulnerable environments for the spread of antimicrobial resistance.
Purpose of the Study:
- To determine the prevalence and molecular epidemiology of ESBL-producing Enterobacterales in Swiss LTCFs.
- To identify intrainstitutional and regional clusters of resistant pathogens.
- To pinpoint factors associated with ESBL colonization in residents.
Main Methods:
- A cross-sectional point prevalence study was conducted in 16 Swiss LTCFs.
- Residents were screened for ESBL-producing Enterobacterales (ESBL-E), and whole-genome sequencing (WGS) was performed.
- Institution- and resident-level data were collected, and a generalized linear model was used for analysis.
Main Results:
- ESBL-E prevalence was 11.6% among 606 participating residents.
- Multilocus sequence type (ST) 131, particularly subclone H30R1, was the most common *Escherichia coli*.
- Independent risk factors for ESBL carriage included prior colonization, male gender, and proton-pump inhibitor (PPI) use.
Conclusions:
- While overall ESBL-E prevalence is low in Swiss LTCFs, localized clusters necessitate targeted infection control.
- Proton-pump inhibitor (PPI) use emerged as a modifiable risk factor, suggesting a need to restrict its use in LTCFs.
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