Household carriage and acquisition of extended-spectrum β-lactamase–producing Enterobacteriaceae: A systematic review

• Published in: Infection control and hospital epidemiology Vol. 41; no. 3; pp. 286 - 294
• Main Authors: Martischang, Romain, Riccio, Maria E., Abbas, Mohamed, Stewardson, Andrew J., Kluytmans, Jan A. J. W., Harbarth, Stephan
• Format: Journal Article
• Language: English
• Published: United States Cambridge University Press 01.03.2020
• Subjects: Antibiotics; Bacteria; beta-Lactamases - isolation & purification; Bibliographic literature; Carrier State - epidemiology; Carrier State - microbiology; Cross-sectional studies; E coli; Enterobacteriaceae; Enterobacteriaceae Infections - epidemiology; Epidemiology; Escherichia coli; Escherichia coli Infections; Family Characteristics; Heterogeneity; Households; Humans; Klebsiella Infections; Klebsiella pneumoniae; Literature reviews; Longitudinal studies; Observational studies; Open source software; Pathogens; Systematic review; Canada
• ISSN: 0899-823X; 1559-6834; 1559-6834
• DOI: 10.1017/ice.2019.336

The epidemiology of ESBL-producing Enterobacteriaceae (ESBL-PE) has been extensively studied in hospitals, but data on community transmission are scarce. We investigated ESBL-PE cocarriage and acquisition in households using a systematic literature review. We conducted a systematic literature search to retrieve cross-sectional or cohort studies published between 1990 and 2018 evaluating cocarriage proportions and/or acquisition rates of ESBL-PE among household members, without language restriction. We excluded studies focusing on animal-to-human transmission or conducted in nonhousehold settings. The main outcomes were ESBL-PE cocarriage proportions and acquisition rates, stratified according to phenotypic or genotypic assessment of strain relatedness. Cocarriage proportions of clonally related ESBL-PE were transformed using the double-arcsine method and were pooled using a random-effects model. Potential biases were assessed manually. We included 13 studies. Among 863 household members of ESBL-PE positive index cases, prevalence of ESBL-PE cocarriage ranged from 8% to 37%. Overall, 12% (95% confidence interval [CI], 8%-16%) of subjects had a clonally related strain. Those proportions were higher for Klebsiella pneumoniae (20%-25%) than for Escherichia coli (10%-20%). Acquisition rates of clonally related ESBL-PE among 180 initially ESBL-PE-free household members of a previously identified carrier ranged between 1.56 and 2.03 events per 1,000 person weeks of follow-up. We identified multiple sources of bias and high heterogeneity (I2, 70%) between studies. ESBL-PE household cocarriage is frequent, suggesting intrafamilial acquisition. Further research is needed to evaluate the risk and control of ESBL-PE household transmission.