Riccio, Maria EVerschuuren, TessConzelmann, NadineMartak, DanielMeunier, AlexandreSalamanca, ElenaDelgado, MercedesGuther, JuliaPeter, SilkePaganini, JulianMartischang, RomainSauser, Juliende Kraker, Marlieke E ACherkaoui, AbdessalamFluit, Ad CCooper, Ben SHocquet, DidierKluytmans, Jan A J WTacconelli, EvelinaRodriguez-Baño, JesúsHarbarth, StephanMODERN WP2 study group2023-02-092023-02-092021-01-07http://hdl.handle.net/10668/16945This study aimed to determine rates and risk factors of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) acquisition and transmission within households after hospital discharge of an ESBL-PE-positive index patient. Two-year prospective cohort study in five European cities. Patients colonized with ESBL-producing Escherichia coli (ESBL-Ec) or Klebsiella pneumoniae (ESBL-Kp), and their household contacts were followed up for 4 months after hospital discharge of the index case. At each follow up, participants provided a faecal sample and personal information. ESBL-PE whole-genome sequences were compared using pairwise single nucleotide polymorphism-based analysis. We enrolled 71 index patients carrying ESBL-Ec (n = 45), ESBL-Kp (n = 20) or both (n = 6), and 102 household contacts. The incidence of any ESBL-PE acquisition among household members initially free of ESBL-PE was 1.9/100 participant-weeks at risk. Nineteen clonally related household transmissions occurred (case to contact: 13; contact to case: 6), with an overall rate of 1.18 transmissions/100 participant-weeks at risk. Most of the acquisition and transmission events occurred within the first 2 months after discharge. The rate of ESBL-Kp household transmission (1.16/100 participant-weeks) was higher than of ESBL-Ec (0.93/100 participant-weeks), whereas more acquisitions were noted for ESBL-Ec (1.06/100 participant-weeks) compared with ESBL-Kp (0.65/100 participant-weeks). Providing assistance for urinary and faecal excretion to the index case by household members increased the risk of ESBL-PE transmission (adjusted prevalence ratio 4.3; 95% CI 1.3-14.1). ESBL-PE cases discharged from the hospital are an important source of ESBL-PE transmission within households. Most acquisition and transmission events occurred during the first 2 months after hospital discharge and were causally related to care activities at home, highlighting the importance of hygiene measures in community settings. German Clinical Trials Register, DRKS-ID: DRKS00013250.enAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/AcquisitionExtended-spectrum β-lactamaseHouseholdProspective cohort studyTransmissionEnterobacteriaceae InfectionsEscherichia coliFamily CharacteristicsHospitalsHumansKlebsiella pneumoniaePatient DischargeProspective StudiesRisk Factorsbeta-Lactamasesresearch article33421572open access10.1016/j.cmi.2020.12.0241469-0691http://www.clinicalmicrobiologyandinfection.com/article/S1198743X20307849/pdf