Extended-spectrum β-lactamase- and pAmpC-producing Enterobacteriaceae among the general population in a livestock-dense area

C C H Wielders; A H A M van Hoek; P D Hengeveld; C Veenman; C M Dierikx; T P Zomer; L A M Smit; W van der Hoek; D J Heederik; S C de Greeff; C B M Maassen; E van Duijkeren

doi:10.1016/j.cmi.2016.10.013

Extended-spectrum β-lactamase- and pAmpC-producing Enterobacteriaceae among the general population in a livestock-dense area

Clin Microbiol Infect. 2017 Feb;23(2):120.e1-120.e8. doi: 10.1016/j.cmi.2016.10.013. Epub 2016 Oct 20.

Authors

Affiliations

¹ Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment, Bilthoven, The Netherlands. Electronic address: lieke.wielders@rivm.nl.
² Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
³ Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands.

PMID: 27773759
DOI: 10.1016/j.cmi.2016.10.013

Abstract

Objectives: In the Netherlands there is an ongoing debate regarding environmental health risks of livestock farming for neighbouring residents. This explorative study aims to determine the prevalence of carriage of extended-spectrum β-lactamase and/or plasmid-mediated AmpC-producing Enterobacteriaceae (ESBL/pAmpC-E) in the general population living in a livestock-dense area, and to study associations between determinants, including exposure through contact with animals and the environment, and human carriage of ESBL/pAmpC-E.

Methods: A cross-sectional study was performed among 2432 adults (aged 20-72 years) in 12 temporary research centres in the south of the Netherlands, consisting of a questionnaire and analysis of a faecal sample to assess carriage of ESBL/pAmpC-E. Risk factors were analysed using logistic regression.

Results: The prevalence for carriage of ESBL/pAmpC-E was 4.5% (109/2432; 95% CI 3.7-5.4) ranging from 1.4% to 10.9% among the research centres. ESBL/pAmpC resistance genes were detected in Escherichia coli and Klebsiella pneumoniae isolates obtained from these 109 persons and the most common ESBL-resistance genes were bla_CTX-M-15, bla_CTX-M-14/17 and bla_CTX-M-1, originating from 76 participants. Travel in the previous 12 months to Africa, Asia or Latin America (OR 2.82; 95% CI 1.71-4.63), having kept cows for a hobby in the previous 5 years (OR 3.77; 95% CI 1.22-11.64), usage of proton-pump inhibitors (OR 1.84; 95% CI 1.05-3.23), and living within 1000 m of a mink farm (OR 2.26; 95% CI 1.28-3.98) were identified as risk factors. Exposure to poultry was not identified as a risk factor.

Conclusions: Overall, living in close proximity to livestock animals and farms does not seem to be a risk factor for carriage of ESBL/pAmpC-E.

Keywords: AmpC; Antimicrobial resistance; Environment; Extended-spectrum β-lactamases; Livestock farming; Prevalence; Risk factors; β-lactam resistance.

MeSH terms

Adult
Aged
Animals
Bacterial Proteins / genetics*
Comorbidity
Cross-Sectional Studies
Enterobacteriaceae / drug effects
Enterobacteriaceae / genetics*
Enterobacteriaceae Infections / epidemiology*
Enterobacteriaceae Infections / microbiology*
Environmental Exposure
Geography
Humans
Livestock*
Middle Aged
Netherlands / epidemiology
Prevalence
Public Health Surveillance
Risk Factors
Young Adult
beta-Lactamases / genetics*

Substances

Bacterial Proteins
AmpC beta-lactamases
beta-Lactamases