Epidemiology of extended-spectrum β-lactamase–producing Enterobacterales in five US sites participating in the Emerging Infections Program, 2017. (14th November 2022)

• Record Type: Journal Article
• Authors: Duffy, Nadezhda; Karlsson, Maria; Reses, Hannah E.; Campbell, Davina; Daniels, Jonathan; Stanton, Richard A.; Janelle, Sarah J.; Schutz, Kyle; Bamberg, Wendy; Rebolledo, Paulina A.; Bower, Chris; Blakney, Rebekah; Jacob, Jesse T.; Phipps, Erin C.; Flores, Kristina G.; Dumyati, Ghinwa; Kopin, Hannah; Tsay, Rebecca; Kainer, Marion A.; Muleta, Daniel; Byrd-Warner, Benji; Grass, Julian E.; Lutgring, Joseph D.; Rasheed, J. Kamile; Elkins, Christopher A.; Magill, Shelley S.; See, Isaac
• Is Part Of: Infection control and hospital epidemiology. Volume 43:Number 11(2022)
• Page Start: 1586
• Page End: 1594
• Publication Date: 2022-11-14
• Subjects: Nosocomial infections -- Epidemiology -- Periodicals; Health facilities -- Sanitation -- Periodicals; Hospital buildings -- Sanitation -- Periodicals; Cross Infection -- Periodicals; Epidemiology -- Periodicals; Hospitals -- Periodicals; Infection Control -- Periodicals; 614.44
• DOI: 10.1017/ice.2021.496
• Languages: English
• ISSNs: 0899-823X

Abstract

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 bla CTX-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.