CTX-M ESBL-producing Enterobacteriaceae: estimated prevalence in adults in England in 2014
Open Access
- 1 May 2018
- journal article
- research article
- Published by Oxford University Press (OUP) in Journal of Antimicrobial Chemotherapy
- Vol. 73 (5), 1368-1388
- https://doi.org/10.1093/jac/dky007
Abstract
Background: ESBL-producing Enterobacteriaceae (ESBLPE) are increasing in prevalence worldwide and are more difficult to treat than non-ESBLPE. Their prevalence in the UK general population is unknown, as the only previous UK ESBLPE faecal colonization study involved patients with diarrhoea. Objectives: To estimate the prevalence of CTX-M ESBLPE faecal colonization in the general adult population of England in 2014, and investigate risk factors. Methods: A stratified random sample of 58337 registered patients from 16 general practices within four areas of England were invited to participate by returning faeces specimens and self-completed questionnaires. Specimens were tested for ESBLPE and carbapenemase-producing Enterobacteriaceae (CPE). Results: 2430 individuals participated (4% of those invited). The estimated prevalence of colonization with CTX-M ESBLPE in England was 7.3% (95% CI 5.6%-9.4%) (Shropshire 774 participants, 4.9% colonization; Southampton City 740 participants, 9.2%; Newham 612 participants, 12.7%; Heart of Birmingham 234 individuals, 16.0%) and was particularly high in: those born in Afghanistan (10 participants, 60.0% colonization, 95% CI 29.7%-84.2%); those born on the Indian subcontinent (India, Pakistan, Bangladesh or Sri Lanka) (259 participants, 25.0% colonization, 95% CI 18.5%-32.9%); travellers to South Asia (India, Pakistan, Bangladesh, Sri Lanka or Nepal) in the last year (140 participants, 38.5% colonization, 95% CI 27.8%-50.5%); and healthcare domestics (8 participants, unweighted 37.5% colonization, 95% CI 8.5%-75.5%). Risk factors identified included: being born in the Indian subcontinent (aOR 5.4, 95% CI 3.0-9.7); travel to South Asia (aOR 2.9, 95% CI 1.8-4.8) or to Africa, China, South or Central America, South East or Pacific Asia or Afghanistan (aOR 2.6, 95% CI 1.7-4.1) in the last year; and working as a healthcare domestic (aOR 6.2, 95% CI 1.3-31). None of the 48 participants who took co-amoxiclav in the last year was colonized with CTX-M ESBLPE. bla(CTX-M-15) accounted for 66% of CTX-M ESBLPE positives. 0.1% (two participants) were colonized with CPE. Conclusions: CTX-M ESBLPE are established in the general population in England and prevalence is particularly high in people from certain countries of birth or with recent travel. We recommend that these findings be taken into account in guidance on the empirical management of patients presenting with a likely Enterobacteriaceae infection.Funding Information
- Public Health Research Programme (041/0038S)
This publication has 48 references indexed in Scilit:
- Fecal Carriage of Carbapenemase-Producing Enterobacteriaceae: a Hidden Reservoir in Hospitalized and Nonhospitalized PatientsJournal of Clinical Microbiology, 2012
- High community faecal carriage rates of CTX-M ESBL-producing Escherichia coli in a specific population group in Birmingham, UKJournal of Antimicrobial Chemotherapy, 2012
- CTX-M Enzymes: Origin and DiffusionFrontiers in Microbiology, 2012
- Regional survey of CTX-M-type extended-spectrum -lactamases among Enterobacteriaceae reveals marked heterogeneity in the distribution of the ST131 cloneJournal of Antimicrobial Chemotherapy, 2010
- Direct Ertapenem Disk Screening Method for Identification of KPC-Producing Klebsiella pneumoniae and Escherichia coli in Surveillance Swab SpecimensJournal of Clinical Microbiology, 2010
- Spread of bla CTX-M-14 Is Driven Mainly by IncK Plasmids Disseminated among Escherichia coli Phylogroups A, B1, and D in SpainAntimicrobial Agents and Chemotherapy, 2009
- Faecal carriage of extended-spectrum -lactamase-producing Escherichia coli: prevalence, risk factors and molecular epidemiologyJournal of Antimicrobial Chemotherapy, 2008
- Occurrence, prevalence and genetic environment of CTX-M -lactamases in Enterobacteriaceae from Indian hospitalsJournal of Antimicrobial Chemotherapy, 2006
- Rapid and simple detection of bla CTX−M genes by multiplex PCR assayJournal of Medical Microbiology, 2005
- Test Characteristics of Perirectal and Rectal Swab Compared to Stool Sample for Detection of Fluoroquinolone-Resistant Escherichia coli in the Gastrointestinal TractAntimicrobial Agents and Chemotherapy, 2005