Occurrence of Healthcare-Associated Infections (HAIs) by Escherichia coli and Klebsiella spp. producing extended-spectrum β-lactamases (ESBL) and/or carbapenemases in portuguese long-term care facilities

Abstract

Extended-spectrum-β-lactamase (ESBL)- and carbapenemase-producing bacteria are widespread in hospitals, but the extent of this problem in long-term care facilities (LTCFs) is poorly understood. We aimed to elucidate, in the Portuguese regional clinical context, the relevance of LTCFs as a reservoir of <i>Escherichia coli</i> and <i>Klebsiella</i> spp. producing ESBL- and/or carbapenemases (Ec/Kp-ESBL/CARB). Fourteen LTCFs from Portugal, corresponding to units of convalescence (UC/<i>n</i> = 3), medium-term internment and rehabilitation (UMDR/ <i>n</i> = 5), or long-term internment and maintenance (ULDM/<i>n</i> = 6), were analyzed (2016–2019). All patients with Ec/Kp-ESBL/CARB infections acquired during LTCF stay were included, and detailed information was collected. Prevalence of patients with healthcare-associated infections (HAIs) by Ec/Kp-ESBL/CARB did not vary significantly over time (1.48% in 2016–2017, 1.89% in 2017–2018, and 1.90% in 2018–2019), but a statistically significant association with the LTCF typology (ULDM, UMDR) was observed. HAIs were caused by <i>K. pneumoniae</i> (<i>n</i> = 51/54.3%), <i>E. coli</i> (<i>n</i> = 41/43.6%), or both (<i>n</i> = 2/2.1%), producing ESBL (96%) or carbapenemases (4%). Prior colonization (<i>n</i> = 14/16%) corresponded to seven Kp-CARB and seven Ec/Kp-ESBL. The worrying prevalence of patients acquiring HAIs by Ec/Kp-ESBL/CARB, associated with the estimated rates of those already colonized at admission, highlights a relevant role for LTCFs as a reservoir of Ec/Kp-ESBL/CARB. Epidemiological surveillance should be extended to the national level, and colonization screening at LTCF admission implemented systematically.