Travel to Asia is a strong predictor for carriage of cephalosporin resistant E. coli and Klebsiella spp. but does not explain everything; prevalence study at a Norwegian hospital 2014–2016

Laura EspenhainEmail author View ORCID ID profile,
Silje Bakken Jørgensen,
Truls Michael Leegaard,
Michaela Marie Lelek,
Siri Haug Hänsgen,
Britt Nakstad,
Marianne Sunde and
Martin Steinbakk

Antimicrobial Resistance & Infection Control20187:146

https://doi.org/10.1186/s13756-018-0429-7

Received: 23 August 2018
Accepted: 30 October 2018
Published: 29 November 2018

Abstract

Background

We aimed to estimate the prevalence of faecal carriage of extended-spectrum cephalosporin (ESC) resistant E. coli and K. pneumoniae (ESCr-EK) and vancomycin resistant enterococci (VRE) in patients upon hospital admission and identify factors associated with carriage to better target interventions and to guide empirical antibiotic treatment.

Methods

Between October 2014 and December 2016, we recruited patients admitted to a Norwegian university hospital. A rectal swab and questionnaire covering possible risk factors for colonisation were collected upon admission. Isolates were characterized by phenotypic methods. ESCr-EK isolates were subject to whole genome sequencing. We calculated prevalence and adjusted prevalence ratios (aPR) using binomial regression.

Results

Of 747 patients, 45 (6.0%) were colonised with ESCr-EK, none with VRE. The ESCr-EK isolates in 41 patients were multidrug resistant; no isolates were non-suceptible to meropenem. Prevalence of ESCr-EK was higher among travellers to Asia (aPR = 6.6; 95%CI 3.6–12; p < 0.001). No statistical significant difference in carriage was observed between departments, age or any other factors in the univariable analyses.

Conclusions

The observed prevalence of ESCr-EK colonisation upon admission was in the same range but lower than that reported in similar studies from Europe. Travel to Asia was a strong predictor for colonisation of ESCr-EK to be considered when administering empirical antimicrobial treatment. As less than one third of colonised patients had travelled to Asia, and no other factors investigated were found to be strongly associated with carriage, these findings underscore that healthcare personnel must apply standard infection control precautions for all patients.