National point prevalence study on carriage of multidrug-resistant microorganisms in Dutch long-term care facilities in 2018
Authors: van Kleef Esther , Wielders Cornelia C H , Schouls Leo M , Feenstra Sabiena G , Hertogh Cees M P M , Bonten Marc J M , van Weert Yolanda , Tostmann Alma , van der Lubben Mariken , de Greeff Sabine C ,   the PPO study group, Glasner Corinna , Fokkert Karin , Rademakers Emma , Terwee Marja , van Nimwegen Dagmar , Paulich Hans , de Raadt Lisa , Punt Else , den Boogert Elke , Jansen Thera Habben , Voss Andreas , Kluytmans Jan , Vos Greet , Schultsz Constance , Bootsma Martin , van ’t Bosch Gerda , van Sprundel Tineke , Vos Greet , Bergervoet Paul , Schreijer Anja , Sijpkes Gea , van Haastert Corrien , Krom André , van den Brink Patricia , Vesseur Jan , Beckers Astrid , Reedijk Nancy , Rossen John , Savelkoul Paul , Laros Jeroen , van den Dool Carline , Bijkerk Paul , Beijshuizen Berend , Mangen Marie-José , Hertroys Rudy , Altorf-van der Kuil Wieke , van Gaalen Rolina , Alblas Jeroen , Verhoef Linda , Franz Eelco , van Duijkeren Engeline , de Haan Angela , Notermans Daan , Poorter Elsa , Landman Fabian , van der Heide Han , Bakker Jacinta , Groot James , van der Zwaluw Kim , van Santen Marga , van Luit Martijn , Witteveen Sandra , Kuiling Sjoerd , Feenstra Sabiena , van Alebeek Josie , Vermolen Julika , Mennen Marcel , van Maurik Arnold , Smeets Elma 
Published: February 2021

Abstract

Objectives
Long-term care facilities (LTCFs) may act as a reservoir of ESBL-producing Enterobacterales (ESBL-E) and carbapenemase-producing Enterobacterales (CPE) for hospitals and the general population. In this study, we estimated the prevalence and molecular epidemiology of rectal carriage with ESBL-E and CPE in residents of Dutch LTCFs between March 2018 and December 2018.

Methods
LTCFs were geographically selected across the country. For each LTCF, a random sample of residents were tested for ESBL-E and CPE in 2018. To identify risk factors for high carriage prevalence and/or individual carriage, characteristics of LTCFs and of a subset of the tested residents were collected. WGS was conducted on isolates from LTCFs with an ESBL-E prevalence of &gt;10% and all CPE isolates to identify institutional clonal transmission.

Results
A total of 4420 residents of 159 LTCFs were included. The weighted mean ESBL-E prevalence was 8.3% (95% CI: 6.8–10.0) and no CPE were found. In 53 LTCFs (33%), where ESBL-E prevalence was &gt;10%, MLST using WGS (wgMLST) was performed. This included 264 isolates, the majority being Escherichia coli (n = 224) followed by Klebsiella pneumoniae (n = 30). Genetic clusters were identified in more than half (30/53; 57%) of high ESBL-positive LTCFs. Among the E. coli isolates, blaCTX-M-15 (92/224; 41%) and blaCTX-M-27 (40/224; 18%) were the most prevalent ESBL-encoding genes. For K. pneumoniae isolates, the most common was blaCTX-M-15 (23/30; 80%).

Conclusions
The estimated prevalence of ESBL-E rectal carriage in Dutch LTCFs is 8.3% and resistance is observed mainly in E. coli with predominance of blaCTX-M-15 and blaCTX-M-27. ESBL-E prevalence in LTCFs seems comparable to previously reported prevalence in hospitals and the general population.