Comparison of approaches for source attribution of ESBL-producing Escherichia coli in Germany

PLoS One. 2022 Jul 15;17(7):e0271317. doi: 10.1371/journal.pone.0271317. eCollection 2022.

Abstract

Extended-spectrum beta-lactamase (ESBL)-producing Escherichia (E.) coli have been widely described as the cause of treatment failures in humans around the world. The origin of human infections with these microorganisms is discussed controversially and in most cases hard to identify. Since they pose a relevant risk to human health, it becomes crucial to understand their sources and the transmission pathways. In this study, we analyzed data from different studies in Germany and grouped ESBL-producing E. coli from different sources and human cases into subtypes based on their phenotypic and genotypic characteristics (ESBL-genotype, E. coli phylogenetic group and phenotypic antimicrobial resistance pattern). Then, a source attribution model was developed in order to attribute the human cases to the considered sources. The sources were from different animal species (cattle, pig, chicken, dog and horse) and also from patients with nosocomial infections. The human isolates were gathered from community cases which showed to be colonized with ESBL-producing E. coli. We used the attribution model first with only the animal sources (Approach A) and then additionally with the nosocomial infections (Approach B). We observed that all sources contributed to the human cases, nevertheless, isolates from nosocomial infections were more related to those from human cases than any of the other sources. We identified subtypes that were only detected in the considered animal species and others that were observed only in the human population. Some subtypes from the human cases could not be allocated to any of the sources from this study and were attributed to an unknown source. Our study emphasizes the importance of human-to-human transmission of ESBL-producing E. coli and the different role that pets, livestock and healthcare facilities may play in the transmission of these resistant bacteria. The developed source attribution model can be further used to monitor future trends. A One Health approach is necessary to develop source attribution models further to integrate also wildlife, environmental as well as food sources in addition to human and animal data.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Anti-Bacterial Agents / pharmacology
  • Cattle
  • Cross Infection*
  • Dogs
  • Escherichia coli
  • Escherichia coli Infections* / microbiology
  • Germany / epidemiology
  • Horses
  • Humans
  • Phylogeny
  • Swine
  • beta-Lactamases / metabolism

Substances

  • Anti-Bacterial Agents
  • beta-Lactamases

Grants and funding

This work was supported by funding from the European Union’s Horizon 2020 Research and Innovation program under grant agreement No 773830: One Health European Joint Program and is a contribution to the DiSCoVeR Joint Research Project; and by the RESET Consortium which is financially supported by the German Federal Ministry of Education and Research (BMBF) through the German Aerospace Center (DLR) grant numbers 01KI1013A-H The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.