Quantifying within-household transmission of extended-spectrum β-lactamase-producing bacteria. (January 2017)

• Record Type: Journal Article
• Authors: Haverkate, M.R.; Platteel, T.N.; Fluit, A.C.; Cohen Stuart, J.W.; Leverstein-van Hall, M.A.; Thijsen, S.F.T.; Scharringa, J.; Kloosterman, R.C.; Bonten, M.J.M.; Bootsma, M.C.J.
• Is Part Of: Clinical microbiology and infection. Volume 23:Number 1(2017)
• Page Start: 46.e1
• Page End: 46.e7
• Publication Date: 2017-01
• Subjects: Extended-spectrum beta-lactamase (ESBL) -- Within-household transmission -- Enterobacteriaceae -- Mathematical model -- Colonisation; Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1016/j.cmi.2016.08.021
• Languages: English
• ISSNs: 1198-743X

Abstract

Abstract: Objectives: Patients can acquire extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae during hospitalization, and colonized patients may transmit these bacteria after discharge, most likely to household contacts. In this study, ESBL transmission was quantified in households. Methods: Faecal samples were longitudinally collected from hospitalized patients colonized with ESBL-producing bacteria and from their household members during hospitalization of the index patient and at 3, 6, 12 and 18 months. A mathematical household model was developed, which allowed for person-to-person transmission, acquisition from other sources (background transmission), and losing carriage. Next, a deterministic population model with a household structure was created, informed by parameter values found in the household model. Results: In all, 74 index patients and 84 household members were included. In more than half of the household members ESBL-producing bacteria were demonstrated at some time during follow up. Person-to-person transmission occurred at a rate of 0.0053/colonized person/day (0.0025–0.011), background transmission at 0.00015/day (95% CI 0.00002–0.00039), and decolonization at 0.0026/day (0.0016–0.0040) for index patients and 0.0090/day (0.0046–0.018) for household members. The estimated probability of transmission from an index patient to a household contact was 67% and 37% vice versa. Conclusion: There is frequent transmission of ESBL-producing bacteria in households, which may contribute to the observed endemicity of ESBL carriage in the Netherlands. However, the population model suggests that there is not a single dominant acquisition route in the community.