Tina Badinski, Salome N Seiffert, Fabian Grässli, Baharak Babouee Flury, Ulrike Besold, Elsbeth Betschon, Michael Biggel, Angela Brucher, Alexia Cusini, Tamara Dörr, Adrian Egli, Stephan Goppel, Sabine Güsewell, Joelle Keller, Matthias von Kietzell, J Carsten Möller, Oliver Nolte, Manuela Ortner, Tim Roloff, Markus Ruetti, Matthias Schlegel, Helena M B Seth-Smith, Roger Stephan, Reto Stocker, Danielle Vuichard-Gysin, Barbara Willi, Stefan P Kuster, Christian R Kahlert, Philipp Kohler
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In September/October 2022, we performed a cross-sectional study among HCW from 14 institutions in Northeastern Switzerland. HCWs reported risk factors for antimicrobial resistance (covering the last 12-24 months) and provided rectal swabs. Swabs were screened for ESBL-E, CPE, and VRE; whole-genome sequencing (WGS) was performed to assess the genetic relatedness. Logistic regression was used to identify occupational and non-occupational risk factors. Among approximately 22,500 employees, 1,209 participated (median age 46 years, 82% female). Prevalences of ESBL-E (<i>n</i> = 65) and CPE (<i>n</i> = 1) were 5.4% [95% confidence interval (CI) 4.2-6.8] and 0.1% (95% CI 0.0-0.5), respectively; no VREs were detected. In the multivariable analysis, non-European ethnicity [adjusted odds ratio (aOR) 7.0, 95% CI 1.4-27.3], travel to high-risk countries (aOR 4.9, 95% CI 2.5-9.3), systemic antibiotics (aOR 2.1, 95% CI 1.1-3.7), antibiotic eye drops (aOR 4.7, 95% CI 1.7-11.9), and monthly sushi consumption (aOR 2.4, 95% CI 1.4-4.3) were positively associated with ESBL-E colonization, whereas alcohol consumption (aOR 0.5 per glass/week, 95% CI 0.3-0.9) was negatively associated with ESBL-E colonization. Occupational factors showed no association. Among ESBL-<i>Escherichia coli</i>, ST131 (15 of 61, 25%) and <i>bla</i><sub>CTX-M-15</sub> (37/61; 61%) were most common; one isolate co-harbored <i>bla</i><sub>OXA-244</sub>. WGS data did not show relevant clustering. Occupational exposure is not associated with ESBL-E colonization in HCW. 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引用次数: 0
摘要
本研究旨在确定医护人员（HCWs）肠道中产扩展谱β-内酰胺酶肠杆菌（ESBL-E）、产碳青霉烯酶肠杆菌（CPE）和耐万古霉素肠球菌（VRE）定植的流行率、分子流行病学和风险因素。2022 年 9 月/10 月，我们对瑞士东北部 14 家医疗机构的医护人员进行了一项横断面研究。医护人员报告了抗菌药耐药性的风险因素（涵盖过去 12-24 个月），并提供了直肠拭子。对拭子进行了 ESBL-E、CPE 和 VRE 筛查；进行了全基因组测序 (WGS) 以评估遗传相关性。采用逻辑回归法确定职业和非职业风险因素。在约 22,500 名员工中，有 1,209 人参与了这项研究（中位年龄为 46 岁，82% 为女性）。ESBL-E（n = 65）和 CPE（n = 1）的发病率分别为 5.4% [95% 置信区间 (CI) 4.2-6.8] 和 0.1% (95% CI 0.0-0.5)；未检出 VRE。在多变量分析中，非欧洲人种[调整赔率（aOR）7.0，95% CI 1.4-27.3]、前往高风险国家（aOR 4.9，95% CI 2.5-9.3）、全身使用抗生素（aOR 2.1，95% CI 1.1-3.7）、抗生素滴眼液（aOR 4.7，95% CI 1.7-11.9）和每月食用寿司（aOR 2.4，95% CI 1.4-4.3）与 ESBL-E 定植呈正相关，而饮酒（aOR 0.5/杯/周，95% CI 0.3-0.9）与 ESBL-E 定植呈负相关。职业因素与此无关。在 ESBL-Escherichia coli 中，ST131（61 个中的 15 个，25%）和 blaCTX-M-15（37/61；61%）最为常见；一个分离菌株同时携带 blaOXA-244。WGS 数据未显示相关的聚类。职业暴露与高危工人的 ESBL-E 定植无关。鉴于其对公共卫生和抗生素管理的潜在影响，应进一步阐明食用寿司和滴用抗生素眼药水作为风险因素的作用。
Colonization with resistant bacteria in hospital employees: an epidemiological surveillance and typing study.
The objective of this study was to determine the prevalence, molecular epidemiology, and risk factors for gut colonization with extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E), carbapenemase-producing Enterobacterales (CPE), and vancomycin-resistant enterococci (VRE) in healthcare workers (HCWs). In September/October 2022, we performed a cross-sectional study among HCW from 14 institutions in Northeastern Switzerland. HCWs reported risk factors for antimicrobial resistance (covering the last 12-24 months) and provided rectal swabs. Swabs were screened for ESBL-E, CPE, and VRE; whole-genome sequencing (WGS) was performed to assess the genetic relatedness. Logistic regression was used to identify occupational and non-occupational risk factors. Among approximately 22,500 employees, 1,209 participated (median age 46 years, 82% female). Prevalences of ESBL-E (n = 65) and CPE (n = 1) were 5.4% [95% confidence interval (CI) 4.2-6.8] and 0.1% (95% CI 0.0-0.5), respectively; no VREs were detected. In the multivariable analysis, non-European ethnicity [adjusted odds ratio (aOR) 7.0, 95% CI 1.4-27.3], travel to high-risk countries (aOR 4.9, 95% CI 2.5-9.3), systemic antibiotics (aOR 2.1, 95% CI 1.1-3.7), antibiotic eye drops (aOR 4.7, 95% CI 1.7-11.9), and monthly sushi consumption (aOR 2.4, 95% CI 1.4-4.3) were positively associated with ESBL-E colonization, whereas alcohol consumption (aOR 0.5 per glass/week, 95% CI 0.3-0.9) was negatively associated with ESBL-E colonization. Occupational factors showed no association. Among ESBL-Escherichia coli, ST131 (15 of 61, 25%) and blaCTX-M-15 (37/61; 61%) were most common; one isolate co-harbored blaOXA-244. WGS data did not show relevant clustering. Occupational exposure is not associated with ESBL-E colonization in HCW. Given the potential public health and antibiotic stewardship implications, the role of sushi consumption and antibiotic eye drops as risk factors should be further elucidated.
期刊介绍：
Antimicrobial Agents and Chemotherapy (AAC) features interdisciplinary studies that build our understanding of the underlying mechanisms and therapeutic applications of antimicrobial and antiparasitic agents and chemotherapy.
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