A multinational study of colonization with extended spectrum beta-lactamase-producing Enterobacteriaceae in healthcare personnel and family members of carrier patients hospitalized in rehabilitation centres

作者：Adler A^*; Baraniak A; Izdebski R; Fiett J; Salvia A; Samso J V; Lawrence C; Solomon J; Paul M; Lerman Y; Schwartzberg Y; Mordechai E; Rossini A; Fierro J; Lammens C; Malhotra Kumar S; Goossens H; Hryniewicz W; Brun Buisson C; Gniadkowski M; Carmeli Y

来源：Clinical Microbiology and Infection, 2014, 20(8): O516-O523.

DOI：10.1111/1469-0691.12560

• Carriage
• extended spectrum beta-lactamase
• family members
• healthcare workers
• rehabilitation centres

The study aims were: (i) to define the prevalence of and risk factors for colonization by extended spectrum beta-lactamase (ESBL) -producing Enterobacteriaceae (EPE) among healthcare workers (HCWs) and family members (FMs) of EPE-colonized patients in rehabilitation units and (ii) to compare EPE isolates from these three groups. The study included 286 FMs of 194 EPE-carrying patients identified in five rehabilitation units located in Israel, Italy, France and Spain. The EPE were detected in rectal swabs from 26 (9%) of 286 FMs screened. In multivariate analyses, older age of FM, greater mean number of hours spent with the patient, being a daughter or a female spouse of a patient, and chronic lung disease of the patient were significantly associated with carriage in the FM. Escherichia coli was the most common organism (76%), followed by Klebsiella pneumoniae (19%). Isolates were typed by pulsed field gel electrophoresis and multilocus sequence typing, and ESBLs were identified by PCR sequencing. A comparison of paired species isolates from FMs and their respective patient showed that 17 of 23 strains were indistinguishable. EPE were detected in 35 (3.5%, E. coli = 34) of the 1001 HCWs screened. Feeding patients was associated with EPE carriage by HCWs. Only 7 of 23 E. coli subclones cultured from HCWs were also represented among 376 patient-derived ESBL-producing E. coli isolates from the same rehabilitation units. In Spain, a higher proportion of HCWs and FMs were ESBL carriers than elsewhere (p < 0.05). In conclusion, the molecular and epidemiological data suggest that FMs are at higher risk of EPE acquisition from their relative patients than HCWs.

• 出版日期2014-8