Individual- and community-level risk factors for ESBL Enterobacteriaceae colonization identified by universal admission screening in London

J. A. Otter*, A. Natale, R. Batra, O. Tosas Auguet, E. Dyakova, S. D. Goldenberg, J. D. Edgeworth

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

42 Citations (Scopus)


Objectives: We evaluated risk factors for gastrointestinal carriage of Enterobacteriaceae which produce extended-spectrum β-lactamases (ESBL-E), including individual-level variables such as antibiotic use and foreign travel, and community-level variables such as housing and deprivation. Methods: In an observational study in 2015, all patients admitted to a London hospital group were approached to be screened for ESBL-E carriage using rectal swabs for 4 months. Patients completed a risk factor questionnaire. Those with a residential postcode in the local catchment area were linked to a database containing community-level risk factor data. Risk factors for ESBL-E carriage were determined by binary logistic regression. Results: Of 4006 patients, 360 (9.0%) carried ESBL-E. Escherichia coli was the most common organism (77.8%), and CTX-M-type ESBLs were the most common genes (57.9% CTX-M-15 and 20.7% CTX-M-9). In multivariable analysis, risk factors for phenotypic ESBL-E among the 1633 patients with a residential postcode within the local catchment area were: travel to Asia (OR 4.4, CI 2.5–7.6) or Africa (OR 2.4, CI 1.2–4.8) in the 12 months prior to admission, two or more courses of antibiotics in the 6 months prior to admission (OR 2.0, CI 1.3–3.0), and residence in a district with a higher-than-average prevalence of overcrowded households (OR 1.5, CI 1.05–2.2).. Conclusions: Both individual and community variables were associated with ESBL-E carriage at hospital admission. The novel observation that household overcrowding is associated with ESBL-E carriage requires confirmation, but raises the possibility that targeted interventions in the community could help prevent transmission of antibiotic-resistant Gram-negative bacteria.

Original languageEnglish
Pages (from-to)1259-1265
Number of pages7
Issue number10
Early online date6 Mar 2019
Publication statusPublished - 1 Oct 2019


  • Antibiotic resistance
  • Epidemiology
  • ESBL
  • Risk factors
  • Travel


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