Novel insights into pivotal risk factors for rectal carriage of extended‐spectrum‐β‐lactamase‐producing enterobacterales within the general population in Lower Saxony, Germany

Aims To estimate the prevalence of extended‐spectrum‐β‐lactamase (ESBL)‐producing enterobacterales (ESBL‐E) carriage in the general population of Lower Saxony, Germany, and to identify risk factors for being colonized. Methods and Results Participants were recruited through local press and information events. Detection of ESBL‐E by culture was conducted using ESBL‐selective chromagar plates containing third‐generation cephalosporins. Identification of pathogens was performed using matrix‐assisted laser desorption ionization time‐of‐flight (MALDI‐TOF)_technology on Vitek mass spectrometry. Antibiotic susceptibility testing was conducted by microdilution (Vitek II) and an ESBL confirmation assay was carried out using a combination disk test. Of 527 randomly collected stool samples from healthy volunteers, 5.5% were tested positive for ESBL‐E. Post‐stratification for age and gender yielded a similar population estimate (5.9%). People traveling abroad and taking antibiotics had the greatest rectal ESBL‐E carriage. Conclusions Potential risk factors (eg, working in healthcare facilities, recent inpatient stay) did not attribute to rectal ESBL‐E carriage as other factors (eg, travelling, taking antibiotics). Rectal ESBL‐E carriage within the general population seems to be high. Significance and Impact of the Study The known risk factors for carriage with MDRO might not be fully applicable to ESBL‐E and require further examination in order to develop effective strategies for the prevention of ESBL‐E dissemination within the general population.