Prevalence, risk factors and genetic characterisation of extended-spectrum beta-lactamase and carbapenemase-producing Enterobacteriaceae (ESBL-E and CPE): a community-based cross-sectional study, the Netherlands, 2014 to 2016

Background:Theepidemiologyofcarriageofextendedspectrum beta-lactamase-producing (ESBL-E) and carbapenemase-producing Enterobacteriaceae (CPE) in the general population is unknown. Aim: In this observational study, the prevalence and risk factors for intestinal ESBL-E and CPE carriage in the Dutch general population were determined. ESBL-E were characterised. Methods: From 2014 to 2016, ca2,000 residents were invited monthly to complete a questionnaire and provide a faecal sample, which was tested for ESBL-E. The first 1,758 samples were also tested for CPE. Risk factors for ESBL-E carriage were identified by multivariable logistic regression analysis. ESBL-E isolates underwent whole genome sequencing. Results: Of 47,957 individuals invited, 4,177(8.7%) completed the questionnaire and provided a faecal sample. ESBL-E were detected in 186 (4.5%) individuals, resulting in an adjusted prevalence of 5.0%(95% confidence interval(CI):3.4–6.6%). Risk factors were: born outside the Netherlands (odds ratio (OR):1.99;95%CI:1.16−4.54), eating in restaurants>20times/year(OR:1.70;95%CI:1.04−2.76), antibiotic use<6monthsago (OR:2.05;95%CI:1.05−4.03), swimming in sea/ocean < 12 months ago (OR:1.63;95%CI:1.11−2.39), travelling to Africa (OR:3.03;95%CI:1.23−7.46) or Asia (OR:2.00;95%CI: 1.02−3.90)<12months ago, and not changing kitchen towels daily (OR:2.19;95%CI:1.24−3.87). The last had the largest population attributable risk (PAR) (47.5%). Eighty-fourof 189 (44.4%) ESBL-E isolates carried bla _CTX-M-15. Escherichia coli isolates belonged to 70 different sequence types (ST)s, of which ST131 (42/178 isolates; 23.6%) was most prevalent. Associations were observed between IncFIA plasmids and ST131 and bla _CTX-M-27, and between IncI1 and ST88 and bla _{CTX M-1}. No CPE were detected. Conclusions: The prevalence of ESBL-E carriage in the Netherlands’ community-dwelling population is 5.0%. Identified risk factors were mostly travelling (particularly to Asia and Africa) and kitchen hygiene. CPE were not detected.