Hostname: page-component-76fb5796d-zzh7m Total loading time: 0 Render date: 2024-04-25T18:09:32.152Z Has data issue: false hasContentIssue false
  • English
  • Français

Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae in French Nursing Homes: An Association between High Carriage Rate among Residents, Environmental Contamination, Poor Conformity with Good Hygiene Practice, and Putative Resident-to-Resident Transmission

Published online by Cambridge University Press:  10 May 2016

Hélène Cochard ,
Benjamin Aubier ,
Roland Quentin ,
Nathalie van der Mee-Marquet  and
Réseau des Hygiénistes du Centre
Hélène Cochard
Affiliation:
Réseau des Hygiénistes du Centre, Centre Hospitalier Universitaire, Tours, France
Benjamin Aubier
Affiliation:
Réseau des Hygiénistes du Centre, Centre Hospitalier Universitaire, Tours, France
Roland Quentin
Affiliation:
Service de Bactériologie et Hygiène, Centre Hospitalier Universitaire, Tours, France
Nathalie van der Mee-Marquet*
Affiliation:
Réseau des Hygiénistes du Centre, Centre Hospitalier Universitaire, Tours, France Service de Bactériologie et Hygiène, Centre Hospitalier Universitaire, Tours, France
*
Centre Hospitalier Universitaire Service de Bactériologie et Hygiène Réseau des Hygiénistes du Centre Hôpital Trousseau Université de Tours, UMR 1282, 37044 Tours Cedex, France (n.vandermee@chu-tours.fr)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

We evaluated the spread of multidrug-resistant Enterobacteriaceae in 38 nursing homes (NHs) in the Centre region of France.

Methods.

We conducted a multicenter prevalence study and evaluated extended-spectrum β-lactamase- and carbapenemase-producing Enterobacteriaceae (ESBLE and CPE, respectively) colonization of 1,155 residents. The colonizing isolates were studied by randomly amplified polymorphic DNA typing. We observed hygiene practices and studied the contamination of the environment in 8 NHs.

Results.

A total of 114 residents were ESBLE carriers (9.9%); none were CPE carriers. A total of 82.6% of the ESBLE were Escherichia coli. ESBLE colonization was associated with poor health status (P = .002), malignancy (P = .006), urinary incontinence (P = .007), fecal incontinence (P = .002), previous hospitalization (P = .033), and carbapenem treatment (P = .040). The clonal relationship between isolates within NHs suggested resident-to-resident ESBLE transmission in 15 NHs. ESBLE isolates were recovered from 6 of 232 bedrooms studied. A total of 1,533 observations revealed low rates of conformity for hand hygiene (25.7%), the use of gloves (45.9%) and protective clothing (13.3%), and waste management (46.7%). Conformity rates correlated inversely with ESBLE carriage rates.

Conclusions.

In most of the participating NHs, improved application of standard precautions during incontinence care is needed, and greater efforts to clean the environment of residents are required.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 4: Special Topic Issue: Carbapenem-Resistant Enterobacteriaceae and Multidrug-Resistant Organisms , April 2014 , pp. 384 - 389
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

a

Participating physicians and nurses are listed at the end of the text

References

1. Nicolas-Chanoine, M-H, Blanco, J, Leflon-Guibout, V, et al. Intercontinental emergence of Escherichia coli clone O25: H4-ST131 producing CTX-M-15. J Antimicrob Chemother 2008;61:273–281.Google Scholar
2. Nordmann, P, Naas, T, Poirel, L. Global spread of carbapenemase-producing Enterobacteriaceae . Emerg Infect Dis 2011;17:1791–1798.CrossRefGoogle ScholarPubMed
3. Oteo, J, Navarro, C, Cercenado, E, et al. Spread of E. coli strains with high-level cefotaxime and ceftazidime resistance between the community, long-term care facilities, and hospital institutions. J Clin Microbiol 2006;44:2359–2366.Google Scholar
4. Won, SY, Munoz-Price, LS, Lolans, K, Hota, B, Weinstein, RA, Hayden, MK. Emergence and rapid regional spread of Klebsiella pneumoniae carbapenemase–producing Enterobacteriacea . Clin Infect Dis 2011;53:532–540.Google Scholar
5. Arpin, C, Quentin, C, Grobost, F, et al. Nationwide survey of ESBL-producing Enterobacteriaceae in the French community setting. J Antimicrob Chemother 2009;63:1205–1214.Google Scholar
6. van der Mee-Marquet, N, Savoyen, P, Domelier-Valentin, AS, Mouens, C, Quentin, R. CTX-M-type fluoroquinolone-resistant E. coli: analysis of the colonization of residents and inanimate surfaces 1 year after a first case of urinary tract infection at a nursing home in France. Infect Control Hosp Epidemiol 2010;31:968–970.Google Scholar
7. Comité de l'Antibiogramme de la Société Française de Microbiologie. 2012 Recommendations of the Comité de l'Antibiogramme de la Société Française de Microbiologie. http://www.sfm-microbiologie.org/pages/?page=746&rid_page=182.Google Scholar
8. Nordmann, P, Poirel, L, Dortet, L. Rapid detection of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis 2012;18:1503–1507.Google Scholar
9. Pacheco, AB, Guth, BE, Soares, KC, Nishimura, L, de Almeida, DF, Ferreira, LC. Random amplification of polymorphic DNA reveals serotype-specific clonal clusters among enterotoxigenic Escherichia coli strains isolated from humans. J Clin Microbiol 1997;35:1521–1525.CrossRefGoogle ScholarPubMed
10. Clermont, O, Dhanji, H, Upton, M, et al. Rapid detection of the 025b-ST131 clone of Escherichia coli encompassing the CTX-M-15-producing strains. J Antimicrob Chemother 2009;64:274–277.CrossRefGoogle Scholar
11. Ministère de la Santé/Haut Conseil de la Santé Publique/Société Française d'Hygiène Hospitalière. Surveiller et Prévenir les Infections Associées aux Soins. Septembre 2010.Google Scholar
12. Bertrand, X, Amara, M, Sauger, M, et al. Extended-spectrum beta-lactamase-producing Enterobacteriacae: unexpected low prevalence of carriage in elderly French residents. Age Ageing 2012;41:233–237.Google Scholar
13. de Kraker, ME, Jarlier, V, Monen, JC, Heuer, OE, van de Sande, N, Grundmann, H. The changing epidemiology of bacteraemias in Europe: trends from the European Antimicrobial Resistance Surveillance System. Clin Microbiol Infect 2013;18:860–868.Google Scholar
14. Nicolas-Chanoine, MH, Gruson, C, Bialek-Davenet, S, et al. 10-Fold increase (2006–11) in the rate of healthy subjects with extended-spectrum β-lactamase-producing Escherichia coli faecal carriage in a Parisian check-up centre. J Antimicrob Chemother 2013;68:562–568.Google Scholar
15. Rooney, PJ, O'Leary, MC, Loughrey, AC, et al. Nursing homes as a reservoir of ESBL-producing ciprofloxacin-resistant E. coli . J Antimicrob Chemother 2009;64:635–641.Google Scholar
16. Jans, B, Schoevaerdts, D, Huang, TD, et al. Epidemiology of multidrug-resistant microorganisms among nursing home residents in Belgium. PLOS ONE 2013;8(5):e64908.CrossRefGoogle ScholarPubMed
17. Lucet, JC, Chevret, S, Decre, D, et al. Outbreak of multiply resistant Enterobacteriaceae in an intensive care unit: epidemiology and risk factors for acquisition. Clin Infect Dis 1996;22:430–436.Google Scholar
18. Tandé, D, Boisramé-Gastrin, S, Münck, MR, et al. Intrafamilial transmission of extended-spectrum-beta-lactamase-producing Escherichia coli and Salmonella enterica Babelsberg among the families of internationally adopted children. J Antimicrob Chemother 2010;65:859–865.Google Scholar
19. Wiener, J, Quinn, JP, Bradford, PA, Goering, RV, Nathan, C, Bush, K, Weinstein, RA. Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. JAMA 1999;281:517–523.Google Scholar