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Epidemiology of extended-spectrum β-lactamase–producing Enterobacterales in five US sites participating in the Emerging Infections Program, 2017

Published online by Cambridge University Press:  14 February 2022

Nadezhda Duffy*
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Maria Karlsson
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Hannah E. Reses
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Davina Campbell
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Jonathan Daniels
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Richard A. Stanton
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Sarah J. Janelle
Affiliation:
Colorado Department of Public Health and Environment, Denver, Colorado
Kyle Schutz
Affiliation:
Colorado Department of Public Health and Environment, Denver, Colorado
Wendy Bamberg
Affiliation:
Colorado Department of Public Health and Environment, Denver, Colorado
Paulina A. Rebolledo
Affiliation:
Emory University School of Medicine, Atlanta, Georgia Georgia Emerging Infections Program, Atlanta, Georgia
Chris Bower
Affiliation:
Emory University School of Medicine, Atlanta, Georgia Georgia Emerging Infections Program, Atlanta, Georgia Atlanta Veterans’ Affairs Medical Center, Decatur, Georgia Foundation for Atlanta Veterans Education and Research, Decatur, Georgia
Rebekah Blakney
Affiliation:
Emory University School of Medicine, Atlanta, Georgia Georgia Emerging Infections Program, Atlanta, Georgia Atlanta Veterans’ Affairs Medical Center, Decatur, Georgia Foundation for Atlanta Veterans Education and Research, Decatur, Georgia
Jesse T. Jacob
Affiliation:
Emory University School of Medicine, Atlanta, Georgia Georgia Emerging Infections Program, Atlanta, Georgia
Erin C. Phipps
Affiliation:
University of New Mexico, Albuquerque, New Mexico New Mexico Emerging Infections Program, Santa Fe, New Mexico
Kristina G. Flores
Affiliation:
University of New Mexico, Albuquerque, New Mexico New Mexico Emerging Infections Program, Santa Fe, New Mexico
Ghinwa Dumyati
Affiliation:
New York Rochester Emerging Infections Program at the University of Rochester Medical Center, Rochester, New York
Hannah Kopin
Affiliation:
New York Rochester Emerging Infections Program at the University of Rochester Medical Center, Rochester, New York
Rebecca Tsay
Affiliation:
New York Rochester Emerging Infections Program at the University of Rochester Medical Center, Rochester, New York
Marion A. Kainer
Affiliation:
Tennessee Department of Health, Nashville, Tennessee
Daniel Muleta
Affiliation:
Tennessee Department of Health, Nashville, Tennessee
Benji Byrd-Warner
Affiliation:
Tennessee Department of Health, Nashville, Tennessee
Julian E. Grass
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Joseph D. Lutgring
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
J. Kamile Rasheed
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Christopher A. Elkins
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Shelley S. Magill
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Isaac See
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Author for correspondence: Nadezhda Duffy, E-mail: nduffy@cdc.gov

Abstract

Objective

The incidence of infections from extended-spectrum β-lactamase (ESBL)–producing Enterobacterales (ESBL-E) is increasing in the United States. We describe the epidemiology of ESBL-E at 5 Emerging Infections Program (EIP) sites.

Methods

During October–December 2017, we piloted active laboratory- and population-based (New York, New Mexico, Tennessee) or sentinel (Colorado, Georgia) ESBL-E surveillance. An incident case was the first isolation from normally sterile body sites or urine of Escherichia coli or Klebsiella pneumoniae/oxytoca resistant to ≥1 extended-spectrum cephalosporin and nonresistant to all carbapenems tested at a clinical laboratory from a surveillance area resident in a 30-day period. Demographic and clinical data were obtained from medical records. The Centers for Disease Control and Prevention (CDC) performed reference antimicrobial susceptibility testing and whole-genome sequencing on a convenience sample of case isolates.

Results

We identified 884 incident cases. The estimated annual incidence in sites conducting population-based surveillance was 199.7 per 100,000 population. Overall, 800 isolates (96%) were from urine, and 790 (89%) were E. coli. Also, 393 cases (47%) were community-associated. Among 136 isolates (15%) tested at the CDC, 122 (90%) met the surveillance definition phenotype; 114 (93%) of 122 were shown to be ESBL producers by clavulanate testing. In total, 111 (97%) of confirmed ESBL producers harbored a blaCTX-M gene. Among ESBL-producing E. coli isolates, 52 (54%) were ST131; 44% of these cases were community associated.

Conclusions

The burden of ESBL-E was high across surveillance sites, with nearly half of cases acquired in the community. EIP has implemented ongoing ESBL-E surveillance to inform prevention efforts, particularly in the community and to watch for the emergence of new ESBL-E strains.

Type
Original Article
Creative Commons
This is a work of the US Government and is not subject to copyright protection within the United States. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America.
Copyright
© Centers for Disease Control and Prevention, 2022

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Footnotes

a

Authors of equal contribution.

PREVIOUS PRESENTATION. Preliminary findings were reported at the 2019 SHEA Spring conference on April 25, 2019, in Boston, Massachusetts.

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