Evidence of Sexual Transmission of Extended-Spectrum β-Lactamase–Producing Enterobacterales: A Cross-sectional and Prospective Study . (21st March 2022)

• Record Type: Journal Article
• Authors: Surgers, Laure; Chiarabini, Thibault; Royer, Guilhem; Rougier, Hayette; Mercier-Darty, Mélanie; Decré, Dominique; Valin, Nadia; Woerther, Paul-Louis; Decousser, Jean-Winoc; Girard, Pierre-Marie; Lacombe, Karine; Boyd, Anders
• Is Part Of: Clinical infectious diseases. Volume 75:Number 9(2022)
• Page Start: 1556
• Page End: 1564
• Publication Date: 2022-03-21
• Subjects: antibiotic resistance -- Enterobacterales -- sexual transmission -- carriage -- epidemiology; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciac218
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Extended-spectrum β-lactamase–producing Enterobacterales (ESBL-E) represent a major threat to public health. Little is known on their potential for sexual transmission. Methods: We recruited individuals at a sexually transmitted infection and human immunodeficiency virus (HIV) outpatient clinic in Paris, France, in whom we evaluated the prevalence of ESBL-E intestinal carriage and, among those testing positive, the proportion with clearance 6 months thereafter. We compared carriage prevalence between groups using logistic regression adjusted for age, geographic origin, travel outside Europe, and antibiotic use in the past 6 months. Results: A total of 2157 individuals participated, of whom 226 (10.5%) were ESBL-E carriers. The proportions of ESBL-E carriers varied across sexual groups and were as follows: HIV-negative men who have sex with men (MSM) and who were on preexposure prophylaxis (PrEP), 16.3% (41 of 251); HIV-negative MSM not on PrEP, 9.7% (47 of 487); HIV-positive MSM, 12.2% (61 of 500); HIV-negative men who have sex exclusively with women, 10.0% (44 of 439); and HIV-negative women who have sex with men, 6.9% (n = 33 of 480). After adjustment, ESBL-E prevalence was significantly higher in HIV-negative MSM on PrEP ( P < .001) and HIV-positive MSM ( P = .01) than in women who have sex with men. A higher number of sexual partners in the past 6 months was associated with ESBL-E carriage after adjustment ( P = .004). Escherichia coli sequence type 14 and bla SHV-12–producing ESBL-E were observed only in MSM. Of 102 individuals with ESBL-E returning for testing, 26 (25%) had carriage at 6 months. Conclusion: ESBL-E carriage is more frequent in MSM undergoing PrEP or living with HIV and with increasing number of sexual partners. More research is warranted to understand the consequences of ESBL-E carriage in these populations and how transmission can be reduced. Abstract : As with other bacteria, there is evidence that extended-spectrum β-lactamase–producing Enterobacterales (ESBL-E) are sexually transmissible. Individuals with increased sexual activity could represent an important reservoir for ESBL-E transmission and could be a potential source for highly transmissible clones.