Dynamics of intestinal carriage of Extended-spectrum Beta-lactamase producing Enterobacteriaceae in the Dutch general population (2014-2016).

BACKGROUND In the Netherlands the prevalence of intestinal Extended-spectrum Beta-lactamase producing Enterobacteriaceae (ESBL-E) carriage in community-dwelling subjects is ~5%. Little is known about the dynamics of ESBL-E carriage. METHODS In a nation-wide population-based study (2014-2016) with 4,177 community-dwelling subjects, fecal samples from 656 subjects were also collected after one (T=1) and six (T=2) months. Growth of ESBL-E was quantified and whole genome sequence analysis performed. Subjects were categorized as "incidental", "short-term", "long-term" carrier or as "non-carrier". Risk factors were determined by random forest models and logistic regression. Transmissibility and duration of ESBL-E carriage was quantified using a transmission model also using previous study data. RESULTS Out of 656 participants, 96 were ESBL-E carrier at T=0. Sixty-six (10.1%) subjects were "incidental carriers", 22 (3.3%) "short-term carriers", 38 (5.8%) "long-term carriers" and 530 (80.8%) "non-carrier". Risk factors for long-term carriage were travelling to Asia, swimming in sea/ocean, and not changing the kitchen towel daily. The log-transformed CFU ratio at T=0 was predictive for ESBL-E carriage at T=1 (OR: 1.3, 95%CI: 1.2-1.6) and T=2 (OR: 1.2, 95%CI: 1.1-1.4). Model simulations revealed a median decolonization rate of 2.83/year, an average duration of carriage of 0.35 years and an acquisition rate of 0.34/year. The trend of the acquisition rate during the study period was close to zero. CONCLUSION Risk factors for long-term ESBL-E carriage were travel and hygiene related . The dynamics of ESBL-E carriage in the general Dutch population are characterized by balancing decolonization and acquisition rates.