Objectives

Infections as a result of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) are considered infections with a high public health burden. In this study, we aimed to identify incidences of and risk factors for healthcare-associated infections (HAIs) after rectal colonization with ESBL-producing Escherichia coli (ESBL-EC) or Klebsiella pneumoniae (ESBL-KP).

Methods

This prospective cohort study was performed in 2014 and 2015. Patients colonized with ESBL-EC or ESBL-KP were monitored for subsequent HAI with ESBL-E and other pathogens. In the case of an ESBL-E infection, rectal and clinical isolates were compared using pulsed-field gel electrophoresis (PFGE), and whole-genome sequencing (WGS) for ESBL-KP isolates. Proportional hazard models were applied to identify risk factors for HAIs, and to analyse competing risks.

Results

Among all patients admitted to the hospital during the study period, 13.6% were rectally screened for third-generation cephalosporin-resistant Enterobacterales (3GCREB). A total of 2386 rectal carriers of ESBL-EC and 585 of ESBL-KP were included in the study. Incidence density (ID) for HAI with ESBL-E was 2.74 per 1000 patient days at risk (95% confidence interval (CI) 2.16–3.43) among carriers of ESBL-EC, while it was 4.44 per 1000 patient days at risk (95% CI 3.17–6.04) among carriers of ESBL-KP. In contrast, ID for HAI with other pathogens was 4.36 per 1000 patient days at risk (95% CI 3.62–5.21) among carriers of ESBL-EC, and 5.00 per 1000 patient days at risk (95% CI 3.64–6.69) among carriers of ESBL-KP. Cox proportional hazard regression analyses identified colonization with ESBL-KP (HR = 1.58, 95% CI 1.068–2.325) compared with ESBL-EC as independent risk factor for HAI with ESBL-E. The results were consistent over all competing risk analyses.

Conclusions

Clinicians should be aware of the increased risk of ESBL-E infections among patients colonized with ESBL-KP compared with ESBL-EC that might be caused by underlying diseases, higher pathogenicity of ESBL-KP and other factors.

中文翻译：

---

产ESBL的大肠杆菌或肺炎克雷伯菌在直肠定殖后，由产生广谱β-内酰胺酶的肠杆菌引起的感染。

目标

由于产生广谱β-内酰胺酶的肠杆菌（ESBL-E）导致的感染被认为具有很高的公共卫生负担。在这项研究中，我们旨在确定在产ESBL的大肠杆菌（ESBL-EC）或肺炎克雷伯菌（ESBL-KP）直肠定植后，医疗相关感染（HAIs）的发生率和危险因素。

方法

这项前瞻性队列研究于2014年和2015年进行。对ESBL-EC或ESBL-KP菌落定植的患者进行了ESBL-E和其他病原体随后的HAI监测。对于ESBL-E感染，使用脉冲场凝胶电泳（PFGE）和全基因组测序（WGS）比较ESBL-KP分离株的直肠和临床分离株。应用比例风险模型来识别HAI的风险因素，并分析竞争风险。

结果

在研究期间入院的所有患者中，对13.6％的第三代头孢菌素耐药肠杆菌（3GCREB）进行了直肠筛查。该研究总共包括2386个ESBL-EC直肠载体和585个ESBL-KP直肠载体。在ESBL-EC携带者中，带有ESBL-E的HAI的发生密度（ID）为每千个患者日2.74（95％置信区间（CI）2.16–3.43），而每1000个患者日为4.44（95） ESBL-KP运营商中的百分比CI 3.17–6.04）。相比之下，在ESBL-EC携带者中，HAI和其他病原体的ID风险为每千个患者日4.36（95％CI 3.62–5.21），携带者中每千个患者日5.00（95％CI 3.64–6.69） ESBL-KP。Cox比例风险回归分析确定了ESBL-KP的定植（HR = 1.58，95％CI 1.068–2。325）与ESBL-EC进行比较，将ESBL-E作为HAI的独立危险因素。在所有竞争风险分析中，结果都是一致的。

结论

临床医生应意识到，与ESBL-EC相比，ESBL-KP定植的患者中ESBL-E感染的风险可能是由潜在疾病，ESBL-KP的较高致病性和其他因素引起的。