The aim of this work was to assess the prevalence of carbapenemase-producing and extended-spectrum β-lactamase-producing Enterobacterales (ESBLPE) intestinal carriage among private dwelling residents (PDR) and nursing home residents (NHR) from the catchment area of Hospital Verge de la Cinta (Tortosa. North-Eastern Spain), and to depict clinicoepidemiological features of colonized individuals. Prevalence of ESBLPE carriage amid 762 PDR (0–94 years) who had feces collected for routine culture was 7.3% and 31% among 71 NHR (68–98 years) screened upon hospital admission. The mean age of colonized and noncolonized subjects was 30 and 32.8 years in PDR (p = 0.58) and 85 and 87 years in NHR (p = 0.32). The predominant ESBLPE was CTX-M-15-producing Escherichia coli (42.8% in PDR and 68.2% in NHR [25% and 86.7% belonging to O25b-ST131 clone; p < 0.0001]), followed by CTX-M-9-group- and SHV-producing E. coli and by CTX-M-15-producing Klebsiella pneumoniae. Overall, 72.7% of ESBLPE were multidrug resistant and 46.2% carried transferable quinolone determinants. Institutionalization in a nursing home was a risk factor for ESBLPE and extended-spectrum β-lactamase (ESBL)-producing O25b-ST131 E. coli carriage in individuals over 67 years (odds ratio 7.7 and 14.1). Previous antibiotic use and skin ulcers were significantly associated with ESBLPE carriage in NHR. Age <25 years in PDR and amoxicillin/clavulanate exposure in NHR protected against ESBL-producing O25b-ST131 E. coli colonization. Only two PDR, with known risk factors, bore OXA-48-producing isolates. These results highlight the role of nonhospitalized intestinal carriers, particularly NHR, as ESBLPE reservoirs and the preponderance of CTX-M-15, mainly linked to O25b-ST131 clone, as well as the emergence of carbapenemase-producing Enterobacterales carriers.

中文翻译：

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产超广谱β-内酰胺酶和碳青霉烯酶的肠杆菌 门诊患者肠道携带：私人住宅居民和疗养院居民之间的微生物学和流行病学差异

这项工作的目的是评估 Hospital Verge 集水区的私人住宅居民 (PDR) 和疗养院居民 (NHR) 中产碳青霉烯酶和超广谱产 β-内酰胺酶肠杆菌 (ESBLPE) 肠道携带的流行率de la Cinta (Tortosa. North-Eastern Spain)，并描述被殖民者的临床流行病学特征。在 762 名收集粪便进行常规培养的 PDR（0-94 岁）中 ESBLPE 携带率分别为 7.3% 和 31%，在入院时筛查的 71 名 NHR（68-98 岁）中。PDR 中定植和非定植受试者的平均年龄为 30 岁和 32.8 岁（p  = 0.58），NHR 中为 85 岁和 87 岁（p  = 0.32）。主要的 ESBLPE 是产 CTX-M-15 的大肠杆菌（在 PDR 中为 42.8%，在 NHR 中为 68.2% [25% 和 86.7% 属于 O25b-ST131 克隆；p  < 0.0001]），其次是 CTX-M-9-组-和 SHV-生产大肠杆菌以及 CTX-产 M-15 的肺炎克雷伯菌。总体而言，72.7% 的 ESBLPE 具有多重耐药性，46.2% 带有可转移的喹诺酮决定簇。养老院的机构化是67 岁以上个体携带 ESBLPE 和产生超广谱 β-内酰胺酶 (ESBL) 的 O25b-ST131大肠杆菌的危险因素（优势比为 7.7 和 14.1）。以前的抗生素使用和皮肤溃疡与 NHR 中 ESBLPE 的携带显着相关。PDR 中的年龄 <25 岁和 NHR 中的阿莫西林/克拉维酸暴露可防止产生 ESBL 的 O25b-ST131大肠杆菌殖民化。只有两个具有已知风险因素的 PDR 携带产生 OXA-48 的分离株。这些结果强调了非住院肠道携带者，特别是 NHR，作为 ESBLPE 储存库的作用和 CTX-M-15 的优势，主要与 O25b-ST131 克隆有关，以及产生碳青霉烯酶的肠杆菌携带者的出现。