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CTX-M ESBL-producing enterobacteriaceae: estimated prevalence in adults in England in 2014

CTX-M ESBL-producing enterobacteriaceae: estimated prevalence in adults in England in 2014
CTX-M ESBL-producing enterobacteriaceae: estimated prevalence in adults in England in 2014

Background: ESBL-producing Enterobacteriaceae (ESBLPE) are increasing in prevalence worldwide and are more difficult to treat than non-ESBLPE. Their prevalence in the UK general population is unknown, as the only previous UK ESBLPE faecal colonization study involved patients with diarrhoea. Objectives: To estimate the prevalence of CTX-M ESBLPE faecal colonization in the general adult population of England in 2014, and investigate risk factors. Methods: A stratified random sample of 58337 registered patients from 16 general practices within four areas of England were invited to participate by returning faeces specimens and self-completed questionnaires. Specimens were tested for ESBLPE and carbapenemase-producing Enterobacteriaceae (CPE). Results: 2430 individuals participated (4% of those invited). The estimated prevalence of colonization with CTX-M ESBLPE in England was 7.3% (95% CI 5.6%-9.4%) (Shropshire 774 participants, 4.9% colonization; Southampton City 740 participants, 9.2%; Newham 612 participants, 12.7%; Heart of Birmingham 234 individuals, 16.0%) and was particularly high in: those born in Afghanistan (10 participants, 60.0% colonization, 95% CI 29.7%-84.2%); those born on the Indian subcontinent (India, Pakistan, Bangladesh or Sri Lanka) (259 participants, 25.0%colonization, 95% CI 18.5%-32.9%); travellers to South Asia (India, Pakistan, Bangladesh, Sri Lanka or Nepal) in the last year (140 participants, 38.5%colonization, 95% CI 27.8%-50.5%); and healthcare domestics (8 participants, unweighted 37.5% colonization, 95% CI 8.5%-75.5%). Risk factors identified included: being born in the Indian subcontinent (aOR 5.4, 95% CI 3.0-9.7); travel to South Asia (aOR 2.9, 95% CI 1.8-4.8) or to Africa, China, South or Central America, South East or Pacific Asia or Afghanistan (aOR 2.6, 95% CI 1.7-4.1) in the last year; and working as a healthcare domestic (aOR 6.2, 95% CI 1.3-31). None of the 48 participants who took co-amoxiclav in the last year was colonized with CTX-M ESBLPE. blaCTX-M-15 accounted for 66% of CTX-M ESBLPE positives. 0.1% (two participants) were colonized with CPE. Conclusions: CTX-M ESBLPE are established in the general population in England and prevalence is particularly high in people from certain countries of birth or with recent travel. We recommend that these findings be taken into account in guidance on the empiricalmanagement of patients presenting with a likely Enterobacteriaceae infection.

0305-7453
1368-1388
McNulty, Cliodna A.M.
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Lecky, Donna M.
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Xu-McCrae, Li
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Nakiboneka-Ssenabulya, Deborah
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Chung, Keun Taik
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Nichols, Tom
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Thomas, Helen Lucy
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Thomas, Mike
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Alvarez-Buylla, Adela
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Turner, Kim
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Shabir, Sahida
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Manzoor, Susan
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Smith, Stephen
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Crocker, Linda
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Hawkey, Peter M.
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McNulty, Cliodna A.M.
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Lecky, Donna M.
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Xu-McCrae, Li
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Nakiboneka-Ssenabulya, Deborah
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Chung, Keun Taik
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Nichols, Tom
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Thomas, Helen Lucy
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Thomas, Mike
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Alvarez-Buylla, Adela
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Turner, Kim
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Shabir, Sahida
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Manzoor, Susan
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Smith, Stephen
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Crocker, Linda
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Hawkey, Peter M.
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McNulty, Cliodna A.M., Lecky, Donna M., Xu-McCrae, Li, Nakiboneka-Ssenabulya, Deborah, Chung, Keun Taik, Nichols, Tom, Thomas, Helen Lucy, Thomas, Mike, Alvarez-Buylla, Adela, Turner, Kim, Shabir, Sahida, Manzoor, Susan, Smith, Stephen, Crocker, Linda and Hawkey, Peter M. (2018) CTX-M ESBL-producing enterobacteriaceae: estimated prevalence in adults in England in 2014. Journal of Antimicrobial Chemotherapy, 73 (5), 1368-1388. (doi:10.1093/jac/dky007).

Record type: Article

Abstract

Background: ESBL-producing Enterobacteriaceae (ESBLPE) are increasing in prevalence worldwide and are more difficult to treat than non-ESBLPE. Their prevalence in the UK general population is unknown, as the only previous UK ESBLPE faecal colonization study involved patients with diarrhoea. Objectives: To estimate the prevalence of CTX-M ESBLPE faecal colonization in the general adult population of England in 2014, and investigate risk factors. Methods: A stratified random sample of 58337 registered patients from 16 general practices within four areas of England were invited to participate by returning faeces specimens and self-completed questionnaires. Specimens were tested for ESBLPE and carbapenemase-producing Enterobacteriaceae (CPE). Results: 2430 individuals participated (4% of those invited). The estimated prevalence of colonization with CTX-M ESBLPE in England was 7.3% (95% CI 5.6%-9.4%) (Shropshire 774 participants, 4.9% colonization; Southampton City 740 participants, 9.2%; Newham 612 participants, 12.7%; Heart of Birmingham 234 individuals, 16.0%) and was particularly high in: those born in Afghanistan (10 participants, 60.0% colonization, 95% CI 29.7%-84.2%); those born on the Indian subcontinent (India, Pakistan, Bangladesh or Sri Lanka) (259 participants, 25.0%colonization, 95% CI 18.5%-32.9%); travellers to South Asia (India, Pakistan, Bangladesh, Sri Lanka or Nepal) in the last year (140 participants, 38.5%colonization, 95% CI 27.8%-50.5%); and healthcare domestics (8 participants, unweighted 37.5% colonization, 95% CI 8.5%-75.5%). Risk factors identified included: being born in the Indian subcontinent (aOR 5.4, 95% CI 3.0-9.7); travel to South Asia (aOR 2.9, 95% CI 1.8-4.8) or to Africa, China, South or Central America, South East or Pacific Asia or Afghanistan (aOR 2.6, 95% CI 1.7-4.1) in the last year; and working as a healthcare domestic (aOR 6.2, 95% CI 1.3-31). None of the 48 participants who took co-amoxiclav in the last year was colonized with CTX-M ESBLPE. blaCTX-M-15 accounted for 66% of CTX-M ESBLPE positives. 0.1% (two participants) were colonized with CPE. Conclusions: CTX-M ESBLPE are established in the general population in England and prevalence is particularly high in people from certain countries of birth or with recent travel. We recommend that these findings be taken into account in guidance on the empiricalmanagement of patients presenting with a likely Enterobacteriaceae infection.

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Accepted/In Press date: 2 January 2018
e-pub ahead of print date: 5 March 2018
Published date: 1 May 2018

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Local EPrints ID: 421480
URI: http://eprints.soton.ac.uk/id/eprint/421480
ISSN: 0305-7453
PURE UUID: 7d9b47ed-ac5e-4a67-a08b-04e1ec40780d

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Date deposited: 13 Jun 2018 16:30
Last modified: 16 Dec 2019 18:12

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Contributors

Author: Cliodna A.M. McNulty
Author: Donna M. Lecky
Author: Li Xu-McCrae
Author: Deborah Nakiboneka-Ssenabulya
Author: Keun Taik Chung
Author: Tom Nichols
Author: Helen Lucy Thomas
Author: Mike Thomas
Author: Adela Alvarez-Buylla
Author: Kim Turner
Author: Sahida Shabir
Author: Susan Manzoor
Author: Stephen Smith
Author: Linda Crocker
Author: Peter M. Hawkey

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