Prevalence and risk factors for carriage of ESBL-producing Enterobacteriaceae in Amsterdam

Research output: Contribution to journalArticleAcademicpeer-review

98 Citations (Scopus)


OBJECTIVES: The objectives of this study were to determine the prevalence of carriage of ESBL-producing Enterobacteriaceae (ESBL-E) in a representative sample of the general adult Dutch community, to identify risk factors and to gain understanding of the epidemiology of these resistant strains.

METHODS: Adults enrolled in five general practices in Amsterdam were approached by postal mail and asked to fill in a questionnaire and to collect a faecal sample. Samples were analysed for the presence of ESBL-E. ESBL genes were characterized by PCR and sequencing. Strains were typed using MLST and amplified fragment length polymorphism (AFLP) and plasmids were identified by PCR-based replicon typing. Risk factors for carriage were investigated by multivariate analysis.

RESULTS: ESBL-E were found in 145/1695 (8.6%) samples; 91% were Escherichia coli. Most ESBL genes were of the CTX-M group (blaCTX-M-1 and blaCTX-M-15). MLST ST131 was predominant and mainly associated with CTX-M-15-producing E. coli. One isolate with reduced susceptibility to ertapenem produced OXA-48. In multivariate analyses, use of antimicrobial agents, use of antacids and travel to Africa, Asia and Northern America were associated with carriage of ESBL-E, in particular strains with blaCTX-M-14/15.

CONCLUSIONS: This study showed a high prevalence of ESBL-E carriage in the general Dutch community. Also, outside hospitals, the use of antibiotics was a risk factor; interestingly, use of antacids increased the risk of carriage. A major risk factor in the general population was travel to countries outside Europe, in particular to Asia, Africa and Northern America.

Original languageEnglish
Pages (from-to)1076-82
Number of pages7
JournalJournal of antimicrobial chemotherapy
Issue number4
Publication statusPublished - Apr 2016


  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Amplified Fragment Length Polymorphism Analysis
  • Carrier State
  • Case-Control Studies
  • Cross-Sectional Studies
  • Enterobacteriaceae
  • Enterobacteriaceae Infections
  • Female
  • Humans
  • Journal Article
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Multilocus Sequence Typing
  • Netherlands
  • Population Surveillance
  • Prevalence
  • Research Support, Non-U.S. Gov't
  • Risk Factors
  • Young Adult
  • beta-Lactam Resistance
  • beta-Lactamases

Cite this