Tina Badinski, Salome N Seiffert, Fabian Grässli, Baharak Babouee Flury, Ulrike Besold, Elsbeth Betschon, Michael Biggel, Angela Brucher, Alexia Cusini, Tamara Dörr, Adrian Egli, Stephan Goppel, Sabine Güsewell, Joelle Keller, Matthias von Kietzell, J Carsten Möller, Oliver Nolte, Manuela Ortner, Tim Roloff, Markus Ruetti, Matthias Schlegel, Helena M B Seth-Smith, Roger Stephan, Reto Stocker, Danielle Vuichard-Gysin, Barbara Willi, Stefan P Kuster, Christian R Kahlert, Philipp Kohler
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In September/October 2022, we performed a cross-sectional study among HCW from 14 institutions in Northeastern Switzerland. HCWs reported risk factors for antimicrobial resistance (covering the last 12-24 months) and provided rectal swabs. Swabs were screened for ESBL-E, CPE, and VRE; whole-genome sequencing (WGS) was performed to assess the genetic relatedness. Logistic regression was used to identify occupational and non-occupational risk factors. Among approximately 22,500 employees, 1,209 participated (median age 46 years, 82% female). Prevalences of ESBL-E (<i>n</i> = 65) and CPE (<i>n</i> = 1) were 5.4% [95% confidence interval (CI) 4.2-6.8] and 0.1% (95% CI 0.0-0.5), respectively; no VREs were detected. In the multivariable analysis, non-European ethnicity [adjusted odds ratio (aOR) 7.0, 95% CI 1.4-27.3], travel to high-risk countries (aOR 4.9, 95% CI 2.5-9.3), systemic antibiotics (aOR 2.1, 95% CI 1.1-3.7), antibiotic eye drops (aOR 4.7, 95% CI 1.7-11.9), and monthly sushi consumption (aOR 2.4, 95% CI 1.4-4.3) were positively associated with ESBL-E colonization, whereas alcohol consumption (aOR 0.5 per glass/week, 95% CI 0.3-0.9) was negatively associated with ESBL-E colonization. Occupational factors showed no association. Among ESBL-<i>Escherichia coli</i>, ST131 (15 of 61, 25%) and <i>bla</i><sub>CTX-M-15</sub> (37/61; 61%) were most common; one isolate co-harbored <i>bla</i><sub>OXA-244</sub>. WGS data did not show relevant clustering. Occupational exposure is not associated with ESBL-E colonization in HCW. 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引用次数: 0
摘要
本研究旨在确定医护人员(HCWs)肠道中产扩展谱β-内酰胺酶肠杆菌(ESBL-E)、产碳青霉烯酶肠杆菌(CPE)和耐万古霉素肠球菌(VRE)定植的流行率、分子流行病学和风险因素。2022 年 9 月/10 月,我们对瑞士东北部 14 家医疗机构的医护人员进行了一项横断面研究。医护人员报告了抗菌药耐药性的风险因素(涵盖过去 12-24 个月),并提供了直肠拭子。对拭子进行了 ESBL-E、CPE 和 VRE 筛查;进行了全基因组测序 (WGS) 以评估遗传相关性。采用逻辑回归法确定职业和非职业风险因素。在约 22,500 名员工中,有 1,209 人参与了这项研究(中位年龄为 46 岁,82% 为女性)。ESBL-E(n = 65)和 CPE(n = 1)的发病率分别为 5.4% [95% 置信区间 (CI) 4.2-6.8] 和 0.1% (95% CI 0.0-0.5);未检出 VRE。在多变量分析中,非欧洲人种[调整赔率(aOR)7.0,95% CI 1.4-27.3]、前往高风险国家(aOR 4.9,95% CI 2.5-9.3)、全身使用抗生素(aOR 2.1,95% CI 1.1-3.7)、抗生素滴眼液(aOR 4.7,95% CI 1.7-11.9)和每月食用寿司(aOR 2.4,95% CI 1.4-4.3)与 ESBL-E 定植呈正相关,而饮酒(aOR 0.5/杯/周,95% CI 0.3-0.9)与 ESBL-E 定植呈负相关。职业因素与此无关。在 ESBL-Escherichia coli 中,ST131(61 个中的 15 个,25%)和 blaCTX-M-15(37/61;61%)最为常见;一个分离菌株同时携带 blaOXA-244。WGS 数据未显示相关的聚类。职业暴露与高危工人的 ESBL-E 定植无关。鉴于其对公共卫生和抗生素管理的潜在影响,应进一步阐明食用寿司和滴用抗生素眼药水作为风险因素的作用。
Colonization with resistant bacteria in hospital employees: an epidemiological surveillance and typing study.
The objective of this study was to determine the prevalence, molecular epidemiology, and risk factors for gut colonization with extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E), carbapenemase-producing Enterobacterales (CPE), and vancomycin-resistant enterococci (VRE) in healthcare workers (HCWs). In September/October 2022, we performed a cross-sectional study among HCW from 14 institutions in Northeastern Switzerland. HCWs reported risk factors for antimicrobial resistance (covering the last 12-24 months) and provided rectal swabs. Swabs were screened for ESBL-E, CPE, and VRE; whole-genome sequencing (WGS) was performed to assess the genetic relatedness. Logistic regression was used to identify occupational and non-occupational risk factors. Among approximately 22,500 employees, 1,209 participated (median age 46 years, 82% female). Prevalences of ESBL-E (n = 65) and CPE (n = 1) were 5.4% [95% confidence interval (CI) 4.2-6.8] and 0.1% (95% CI 0.0-0.5), respectively; no VREs were detected. In the multivariable analysis, non-European ethnicity [adjusted odds ratio (aOR) 7.0, 95% CI 1.4-27.3], travel to high-risk countries (aOR 4.9, 95% CI 2.5-9.3), systemic antibiotics (aOR 2.1, 95% CI 1.1-3.7), antibiotic eye drops (aOR 4.7, 95% CI 1.7-11.9), and monthly sushi consumption (aOR 2.4, 95% CI 1.4-4.3) were positively associated with ESBL-E colonization, whereas alcohol consumption (aOR 0.5 per glass/week, 95% CI 0.3-0.9) was negatively associated with ESBL-E colonization. Occupational factors showed no association. Among ESBL-Escherichia coli, ST131 (15 of 61, 25%) and blaCTX-M-15 (37/61; 61%) were most common; one isolate co-harbored blaOXA-244. WGS data did not show relevant clustering. Occupational exposure is not associated with ESBL-E colonization in HCW. Given the potential public health and antibiotic stewardship implications, the role of sushi consumption and antibiotic eye drops as risk factors should be further elucidated.
期刊介绍:
Antimicrobial Agents and Chemotherapy (AAC) features interdisciplinary studies that build our understanding of the underlying mechanisms and therapeutic applications of antimicrobial and antiparasitic agents and chemotherapy.