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.
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.
['Espenhain|Laura|L|0000-0003-0805-5199', 'Jørgensen|Silje Bakken|SB|', 'Leegaard|Truls Michael|TM|', 'Lelek|Michaela Marie|MM|', 'Hänsgen|Siri Haug|SH|', 'Nakstad|Britt|B|', 'Sunde|Marianne|M|', 'Steinbakk|Martin|M|']
D000293:Adolescent D000328:Adult D000368:Aged D000900:Anti-Bacterial Agents D001208:Asia D018550:Cephalosporin Resistance D002648:Child D002675:Child, Preschool D003430:Cross-Sectional Studies D004756:Enterobacteriaceae Infections D004926:Escherichia coli D004927:Escherichia coli Infections D005243:Feces D005260:Female D006761:Hospitals D006801:Humans D007223:Infant D007231:Infant, Newborn D007709:Klebsiella D007710:Klebsiella Infections D008297:Male D008875:Middle Aged D009664:Norway D015995:Prevalence D012007:Rectum D012307:Risk Factors D014195:Travel D055815:Young Adult D001618:beta-Lactamases
Prevalence Studies Beta-lactam resistance Cross-sectional Drug resistance, multiple Enterobacteriaceae Epidemiology Hospitals, university