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Multi-institutional outbreak of an extended spectrum beta-lactamase producing E coli involving long term care facilities



Multi-institutional outbreak of an extended spectrum beta-lactamase producing E coli involving long term care facilities



Abstracts of the Interscience Conference on Antimicrobial Agents & Chemotherapy 41: 402-403



Background: Few outbreaks of ESBL producing Enterobacteriaceae have been reported outside of hospitals. Fewer than 1% of ECin Ontario are ESBL-EC and in 1998, no ESBL were detected in rectal swabs from >1000 Canadian LTC residents. Methods: In 08/00, 5 patients (pts) colonized/infected (C/I) with an ESBL-EC were identified in a hospital; no hospital links were identified but all 5 were residents of 1 retirement home (RH). Screening (rectal swabs plated on MacConkey agar with 2mg/L cefpodoxime) was conducted at all 20 regional LTCF and 3 regional hospitals. LTCF with C/I residents were re-screened monthly. ESBL-EC were identified by Double Disk test+cefoxitin and by Vitek, and subjected to XbaI PFGE. Results: From 08/00 to 04/01, 119 pts/residents were C/I with PFGE-indistinguishable isolates of MDR ESBL-EC (also resistant to aminoglycosides and fluoroquinolones). 23 acquired the strain in hospital. 96 LTCF residents were C/I: 0/487 in 13 unaffected LTCF, and 96/911 (11%) in 7 involved LTCF. 17 clinical infections and 6 fatalities were due to the outbreak strain. The highest initial colonization rate was at the index RH where 14/87 residents were colonized. Of the colonized residents, only 1 had been in hospital and none had received antibiotics in the preceding 6 mo. None of 85 staff screened at the LTCF were colonized. Transfer of colonized pts to 2 initially uninvolved LTCF was associated with transmission in these facilities. Infection control measures have stopped transmission in 3/6 LTCF. Control efforts are complicated by persistent carriage: of 62 pts followed for a median of 150 days (range 35-210), 75% remained colonized at 5mo, and 71% at 7mo. Conclusions: Dissemination of MDR ESBL E. coli can occur within LTCF in the absence of selective pressure. LTCF may become reservoirs of resistant organisms once widespread colonization of residents has occurred.

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Accession: 035349252

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