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. 2021 Sep;27(9):1322-1329.
doi: 10.1016/j.cmi.2020.12.024. Epub 2021 Jan 7.

Household acquisition and transmission of extended-spectrum β-lactamase (ESBL) -producing Enterobacteriaceae after hospital discharge of ESBL-positive index patients

Maria E Riccio  1 , Tess Verschuuren  2 , Nadine Conzelmann  3 , Daniel Martak  4 , Alexandre Meunier  4 , Elena Salamanca  5 , Mercedes Delgado  5 , Julia Guther  6 , Silke Peter  6 , Julian Paganini  7 , Romain Martischang  1 , Julien Sauser  1 , Marlieke E A de Kraker  1 , Abdessalam Cherkaoui  8 , Ad C Fluit  7 , Ben S Cooper  9 , Didier Hocquet  4 , Jan A J W Kluytmans  2 , Evelina Tacconelli  10 , Jesús Rodriguez-Baño  5 , Stephan Harbarth  11 ; MODERN WP2 study group
Collaborators, Affiliations
Free article

Household acquisition and transmission of extended-spectrum β-lactamase (ESBL) -producing Enterobacteriaceae after hospital discharge of ESBL-positive index patients

Maria E Riccio et al. Clin Microbiol Infect. 2021 Sep.
Free article

Abstract

Objectives: This study aimed to determine rates and risk factors of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) acquisition and transmission within households after hospital discharge of an ESBL-PE-positive index patient.

Methods: Two-year prospective cohort study in five European cities. Patients colonized with ESBL-producing Escherichia coli (ESBL-Ec) or Klebsiella pneumoniae (ESBL-Kp), and their household contacts were followed up for 4 months after hospital discharge of the index case. At each follow up, participants provided a faecal sample and personal information. ESBL-PE whole-genome sequences were compared using pairwise single nucleotide polymorphism-based analysis.

Results: We enrolled 71 index patients carrying ESBL-Ec (n = 45), ESBL-Kp (n = 20) or both (n = 6), and 102 household contacts. The incidence of any ESBL-PE acquisition among household members initially free of ESBL-PE was 1.9/100 participant-weeks at risk. Nineteen clonally related household transmissions occurred (case to contact: 13; contact to case: 6), with an overall rate of 1.18 transmissions/100 participant-weeks at risk. Most of the acquisition and transmission events occurred within the first 2 months after discharge. The rate of ESBL-Kp household transmission (1.16/100 participant-weeks) was higher than of ESBL-Ec (0.93/100 participant-weeks), whereas more acquisitions were noted for ESBL-Ec (1.06/100 participant-weeks) compared with ESBL-Kp (0.65/100 participant-weeks). Providing assistance for urinary and faecal excretion to the index case by household members increased the risk of ESBL-PE transmission (adjusted prevalence ratio 4.3; 95% CI 1.3-14.1).

Conclusions: ESBL-PE cases discharged from the hospital are an important source of ESBL-PE transmission within households. Most acquisition and transmission events occurred during the first 2 months after hospital discharge and were causally related to care activities at home, highlighting the importance of hygiene measures in community settings.

Clinical study registration: German Clinical Trials Register, DRKS-ID: DRKS00013250.

Keywords: Acquisition; Extended-spectrum β-lactamase; Household; Prospective cohort study; Transmission.

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