TY - JOUR
T1 - Quantifying within-household transmission of ESBL-producing bacteria
AU - Haverkate, Manon R
AU - Platteel, Tamara N
AU - Fluit, A C
AU - Cohen Stuart, James W
AU - Leverstein-van Hall, Maurine A
AU - Thijsen, Steven F T
AU - Scharringa, J.
AU - Kloosterman, Fieke R C
AU - Bonten, Marc J M
AU - Bootsma, Martin C J
N1 - Copyright © 2016. Published by Elsevier Ltd.
PY - 2017/1
Y1 - 2017/1
N2 - OBJECTIVES: Patients can acquire extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae during hospitalisation and colonised patients may transmit these bacteria after discharge, most likely to household contacts. In this study, ESBL transmission was quantified in households.METHODS: Fecal samples were longitudinally collected from hospitalised patients colonised with ESBL-producing bacteria and from their household members during hospitalisation of the index patient and at 3, 6, 12, and 18 months. A mathematical household model was developed which allowed for person-to-person transmission, acquisition from other sources (background transmission), and losing carriage. Next, a deterministic population model with a household structure was created, informed by parameter values found in the household model.RESULTS: 74 index patients and 84 household members were included. In more than half of the household members ESBL-producing bacteria were demonstrated at some time during follow up. Person-to-person transmission occurred at a rate of 0.0053/colonised person/day (0.0025-0.011), background transmission at 0.00015/day (95% CI 0.00002-0.00039), and decolonization at 0.0026/day (0.0016-0.0040) for index patients and 0.0090/day (0.0046-0.018) for household members. The estimated probability of transmission from an index patient to a household contact was 67% and 37% vice versa.CONCLUSION: There is frequent transmission of ESBL-producing bacteria in households, which may contribute to the observed endemicity of ESBL carriage in the Netherlands. However, the population model suggests that there is not a single dominant acquisition route in the community.
AB - OBJECTIVES: Patients can acquire extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae during hospitalisation and colonised patients may transmit these bacteria after discharge, most likely to household contacts. In this study, ESBL transmission was quantified in households.METHODS: Fecal samples were longitudinally collected from hospitalised patients colonised with ESBL-producing bacteria and from their household members during hospitalisation of the index patient and at 3, 6, 12, and 18 months. A mathematical household model was developed which allowed for person-to-person transmission, acquisition from other sources (background transmission), and losing carriage. Next, a deterministic population model with a household structure was created, informed by parameter values found in the household model.RESULTS: 74 index patients and 84 household members were included. In more than half of the household members ESBL-producing bacteria were demonstrated at some time during follow up. Person-to-person transmission occurred at a rate of 0.0053/colonised person/day (0.0025-0.011), background transmission at 0.00015/day (95% CI 0.00002-0.00039), and decolonization at 0.0026/day (0.0016-0.0040) for index patients and 0.0090/day (0.0046-0.018) for household members. The estimated probability of transmission from an index patient to a household contact was 67% and 37% vice versa.CONCLUSION: There is frequent transmission of ESBL-producing bacteria in households, which may contribute to the observed endemicity of ESBL carriage in the Netherlands. However, the population model suggests that there is not a single dominant acquisition route in the community.
KW - Extended-spectrum beta-lactamase (ESBL)
KW - Within-household transmission
KW - Enterobacteriaceae
KW - Mathematical model
KW - Colonisation
U2 - 10.1016/j.cmi.2016.08.021
DO - 10.1016/j.cmi.2016.08.021
M3 - Article
C2 - 27596534
SN - 1198-743X
VL - 23
SP - 46.e1–46.e7
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 1
ER -