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. 2021 Dec 6;73(11):e4607-e4615.
doi: 10.1093/cid/ciaa1295.

Household Transmission of Carbapenemase-producing Enterobacterales in Ontario, Canada

Alainna J Jamal  1   2 , Amna Faheem  2 , Lubna Farooqi  2 , Xi Zoe Zhong  2 , Irene Armstrong  1   3 , David A Boyd  4 , Emily Borgundvaag  2 , Brenda L Coleman  1   2 , Karen Green  2 , Kithsiri Jayasinghe  2 , Jennie Johnstone  1   2 , Kevin Katz  5 , Philipp Kohler  2 , Angel X Li  2 , Laura Mataseje  4 , Roberto Melano  6 , Matthew P Muller  1   7 , Michael R Mulvey  4 , Sarah Nayani  2 , Samir N Patel  6 , Aimee Paterson  2 , Susan Poutanen  2 , Anu Rebbapragada  8 , David Richardson  9 , Alicia Sarabia  10 , Shumona Shafinaz  2 , Andrew E Simor  11 , Barbara M Willey  2 , Laura Wisely  2 , Allison J McGeer  1   2
Affiliations

Household Transmission of Carbapenemase-producing Enterobacterales in Ontario, Canada

Alainna J Jamal et al. Clin Infect Dis. .

Abstract

Background: Data on household transmission of carbapenemase-producing Enterobacterales (CPE) remain limited. We studied risk of CPE household co-colonization and transmission in Ontario, Canada.

Methods: We enrolled CPE index cases (identified via population-based surveillance from January 2015 to October 2018) and their household contacts. At months 0, 3, 6, 9, and 12, participants provided rectal and groin swabs. Swabs were cultured for CPE until September 2017, when direct polymerase chain reaction (PCR; with culture of specimens if a carbapenemase gene was detected) replaced culture. CPE risk factor data were collected by interview and combined with isolate whole-genome sequencing to determine likelihood of household transmission. Risk factors for household contact colonization were explored using a multivariable logistic regression model with generalized estimating equations.

Results: Ninety-five households with 177 household contacts participated. Sixteen (9%) household contacts in 16 (17%) households were CPE-colonized. Household transmission was confirmed in 3/177 (2%) cases, probable in 2/177 (1%), possible in 9/177 (5%), and unlikely in 2/177 (1%). Household contacts were more likely to be colonized if they were the index case's spouse (odds ratio [OR], 6.17; 95% confidence interval [CI], 1.05-36.35), if their index case remained CPE-colonized at household enrollment (OR, 7.00; 95% CI, 1.92-25.49), or if they had at least 1 set of specimens processed after direct PCR was introduced (OR, 6.46; 95% CI, 1.52-27.40).

Conclusions: Nine percent of household contacts were CPE-colonized; 3% were a result of household transmission. Hospitals may consider admission screening for patients known to have CPE-colonized household contacts.

Keywords: carbapenem-resistant Enterobacteriaceae; disease transmission; epidemiology; public health; β-lactamases.

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Figures

Figure 1.
Figure 1.
Study flow diagram, including number of newly positive HCs at each study visit. Abbreviations: CPE, carbapenemase-producing Enterobacterales; HC, household contact; IC, index case.
Figure 2.
Figure 2.
Cumulative incidence of CPE colonization among HCs (A) who were not identified as colonized at enrollment (N = 168) and (B) whose index cases remained colonized at enrollment (N = 111). Month 12 visits (per-protocol visits at 365–395 days after enrollment) were delayed in 14 households due to travel or scheduling challenges, resulting in 33 HCs being censored beyond 395 days. Abbreviations: CPE, carbapenemase-producing Enterobacterales; HC, household contact.
See this image and copyright information in PMC

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