OBJECTIVE To determine the prevalence and genotypic characteristics of extended-spectrum β-lactamase-producing Enterobacterales (ESBLE) and carbapenemase-producing Enterobacterales (CPE) in nursing homes (NHs) in a French region. Risk factors associated with their carriage were also investigated. METHODS A point-prevalence survey was proposed from November 2017 to June 2018 to NHs in the study region. Volunteer residents were screened for ESBLE and CPE carriage. Escherichia coli and Klebsiella pneumoniae isolates were genotyped using multi-locus sequence typing, pulsed-field gel electrophoresis (PFGE) and phylogrouping (for E. coli alone). Collective and individual data were analysed by random-effects logistic regression. RESULTS The study was conducted in 18 NHs and included 262 patients. Fifty-two patients (19.8%) carried at least one ESBLE, corresponding to 56 isolates (42 E. coli, 11 K. pneumoniae and three others), while no CPE was detected. The majority (27/42) of ESBL E. coli belonged to phylogroup B2, and ST131 was over-represented in this subset (21/27). PFGE analysis revealed ST131 cross-transmission within NHs. Regarding ESBL K. pneumoniae, nine of 11 isolates belonged to ST663, and PFGE suggested diffusion of the clone in six NHs. Significant individual risk factors for colonization by ESBLE were: use of a shared bathroom, previous antibiotic use and recent history of hospitalization. Significant collective protective factors were proper compliance with glove use and support of the NH by a healthcare facility. CONCLUSION This study shows that NHs in the study region are an important reservoir of ESBLE, whereas no residents were CPE carriers. The control of ESBLE in NHs should focus on antibiotic stewardship and excreta management policies.

中文翻译：

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法国疗养院居民中产生ESBL的肠杆菌运输的普遍性，遗传多样性及与之相关的因素。

目的确定法国地区疗养院（NHs）中产生广谱β-内酰胺酶的产肠杆菌（ESBLE）和产碳青霉烯酶的肠杆菌（CPE）的患病率和基因型特征。还调查了与运输有关的危险因素。方法提议于2017年11月至2018年6月对研究区域的NHs进行点流行度调查。对志愿者居民进行了ESBLE和CPE运输的筛查。使用多位点序列分型，脉冲场凝胶电泳（PFGE）和系统分组（仅针对大肠杆菌）对大肠杆菌和肺炎克雷伯菌分离株进行基因分型。集体和个人数据通过随机效应逻辑回归分析。结果这项研究在18个NHs中进行，纳入262例患者。52位患者（19.8％）携带至少一种ESBLE，对应于56个分离株（42个大肠杆菌，11个肺炎克雷伯菌和其他3个），而未检测到CPE。ESBL大肠杆菌的大多数（27/42）属于phylogroup B2，而ST131在该子集中的代表过多（21/27）。PFGE分析揭示了NHs中的ST131交叉传输。关于ESBL肺炎克雷伯菌，11个分离株中有9个属于ST663，PFGE建议该克隆在六个NH中扩散。ESBLE定植的重要个人危险因素是：使用共用洗手间，以前使用过抗生素以及近期住院的历史。重要的集体保护因素是对手套的正确使用以及医疗机构对NH的支持。结论本研究表明，研究区的NHs是ESBLE的重要储集层，而没有居民是CPE携带者。