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Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2015, Number 5

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Rev Invest Clin 2015; 67 (5)

Intestinal Colonization by Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae in Infants

Huerta-García GC, Miranda-Novales G, Díaz-Ramos R, Vázquez-Rosales G, Solórzano-Santos F

Language: English
References: 27
Page: 313-317
PDF size: 94.74 Kb.


ABSTRACT

Background: Members of the Enterobacteriaceae family are common agents of nosocomial infections. Intestinal colonization by these microorganisms represents a major step in the development of systemic infection. Extended-spectrum b-lactamaseproducing bacteria are usually associated with outbreaks, but endemic infections are common in intensive care units. Objective: To determine the frequency of intestinal colonization with extended-spectrum b-lactamase-producing Enterobacteriaceae in newborns. Patients and Methods: This was a descriptive cohort study. Newborns from two general hospitals (A and B) in Mexico City were included during a five-month period; those with a hospital stay › 7 days were selected. Fecal samples were obtained by rectal swab on day 7 and every week until discharge. Extended-spectrum b-lactamase production was confirmed in enterobacteria by the Etest. Clonal relatedness was established by pulsed-field gel electrophoresis. Results: 102 newborns were included; 63/102 (61.7%) were colonized by extended-spectrum b-lactamase-producing Enterobacteriaceae on day 7, 17/21 (81%) on day 14, and 6/8 (75%) on day 21 of hospitalization. Klebsiella pneumoniae was recovered most frequently (75.4%). A predominant clone (95%) was found in hospital B, and a major clone (75%) in Hospital A. Other extended-spectrum b-lactamase-producing Enterobacteriaceae isolates were Enterobacter spp. (16%) and Escherichia coli (7.6%). Conclusions: High rates of colonization and horizontal transmission of extended-spectrum b-lactamase-producing Enterobacteriaceae were found in the newborn care units of two general hospitals. Clonal relatedness was identified. Lack of adherence to standard precautions and hand hygiene were determining factors.


REFERENCES

  1. Bush K, Fisher JF. Epidemiological expansion, structural studies, and clinical challenges of new b-lactamases from gram-negative bacteria. Annu Rev Microbiol. 2011;65:455-78.

  2. Jacoby GA. Extended spectrum beta-lactamases and other enzymes provided resistance to oximino-betalactams. Infect Dis Clin North Am. 1997;11:875-87.

  3. Turner PJ. Extended-spectrum b-lactamases. Clin Infect Dis. 2005:41(Suppl 4):S273-5.

  4. Thauvin-Eliopoulos C, Tripodi MF, Moellering RC, et al. Efficacies of piperacillin–tazobactam and cefepime in rats with experimental intra-abdominal abscesses due to an extended-spectrum beta-lactamase-producing strain of Klebsiella pneumoniae. Antimicrob Agents Chemother. 1997;41:1053-7.

  5. Bizzarro MJ, Gallagher PG. Antibiotic-resistant organisms in the neonatal intensive care unit. Semin Perinatol. 2007;31:26-32.

  6. Cantón R, Coque TM, Baquero F. Multi-resistant gram-negative bacilli: from epidemics to endemics. Curr Opin Infect Dis. 2003; 16:315-25.

  7. Fernández-Rodríguez A, Cantón R, Pérez-Díaz JC, et al. Aminoglycoside- modifying enzymes in clinical isolates harboring extended-spectrum beta-lactamases. Antimicrob Agents Chemother. 1992;36:2536-8.

  8. Smith DL, Dushoff J, Perencevich EN, et al. Persistent colonization and the spread of antibiotic resistance in nosocomial pathogens: resistance is a regional problem. Proc Natl Acad Sci USA. 2004;101:3709-14.

  9. Boo NY, Ng SF, Lim VK. A case-control study of risk factors associated with rectal colonization of extended-spectrum betalactamase producing Klebsiella sp. in newborn infants. J Hosp Infect. 2005;61:68-74.

  10. Rastogi V, Nirwan PS, Jain S, et al. Nosocomial outbreak of septicaemia in neonatal intensive care unit due to extended spectrum b-lactamase producing Klebsiella pneumoniae showing multiple mechanisms of drug resistance. Indian J Med Microbiol. 2010;28:380-4.

  11. Shakil S, Akram M, Ali SM, et al. Acquisition of extended-spectrum beta-lactamase producing Escherichia coli strains in male and female infants admitted to a neonatal intensive care unit: molecular epidemiology and analysis of risk factors. J Med Microbiol. 2010;59:948-54.

  12. Kristóf K, Szabó D, Marsh JW, et al. Extended-spectrum betalactamase- producing Klebsiella spp. in a neonatal intensive care unit: risk factors for the infection and the dynamics of the molecular epidemiology. Eur J Clin Microbiol Infect Dis. 2007;26: 563-70.

  13. Cormican M, Marshall S, Jones R. Detection of extended-spectrum beta-lactamases (ESBL)-producing strains by Etest ESBL Screen. J Clin Microbiol. 1996;34:1880-4.

  14. Cohen Stuart J, Dierikx C, Al Naiemi N, et al. Rapid detection of TEM, SHV and CTX-M extended-spectrum beta-lactamases in Enterobacteriaceae using ligation-mediated amplification with microarray analysis. J Antimicrob Chemother. 2010;65: 1377-81.

  15. Miranda G, Castro N, Leaños B, et al. Clonal and horizontal dissemination of Klebsiella pneumoniae expressing SHV-5 extended spectrum beta-lactamase in a Mexican pediatric hospital. J Clin Microbiol. 2004;42:30-5.

  16. Tenover FC, Arbeit RD, Goering RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field electrophoresis: criteria for bacterial strain typing. J Clin Microbiol. 1995;33:2233-9.

  17. Kothari C, Gaind R, Singh LC, et al. Community acquisition of b-lactamase producing Enterobacteriaceae in neonatal gut. BMC Microbiol. 2013;13:136.

  18. Nordberg V, Quizhpe Peralta A, Galindo T, et al. High proportion of intestinal colonization with successful epidemic clones of ESBL-producing Enterobacteriaceae in a neonatal intensive care unit in Ecuador. PLoS One. 2013;8:e76597.

  19. Cantey JB, Sreeramoju P, Jaleel M, et al. Prompt control of an outbreak caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit. J Pediatr. 2013;163:672-9.

  20. Tamma PD, Savard P, Pál T, et al. An outbreak of extendedspectrum β-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2012;33:631-4.

  21. Andriatahina T, Randrianirina F, Hariniana ER, et al. High prevalence of fecal carriage of extended-spectrum beta-lactamaseproducing Escherichia coli and Klebsiella pneumoniae in a pediatric unit in Madagascar. BMC Infect Dis. 2010;10:204.

  22. Reddy P, Malczynski M, Obias A, et al. Screening for extendedspectrum beta-lactamase-producing Enterobacteriaceae among high-risk patients and rates of subsequent bacteremia. Clin Infect Dis. 2007;45:846-52.

  23. Tschudin-Sutter S, Frei R, Battegay M, et al. Extended spectrum b-lactamase-producing Escherichia coli in neonatal care unit. Emerg Infect Dis. 2010;16:1758-60.

  24. Gundes S, Arisoy AE, Kolayli F, et al. An outbreak of SHV-5 producing Klebsiella pneumoniae in a neonatal intensive care unit; meropenem failed to avoid fecal colonization. New Microbiol. 2005;28:231-6.

  25. Giuffrè M, Cipolla D, Bonura C, et al. Outbreak of colonizations by extended-spectrum b-lactamase-producing Escherichia coli sequence type 131 in a neonatal intensive care unit, Italy. Antimicrob Resist Infect Control 2013;2:8.

  26. Gastmeier P, Loui A, Stamm-Balderjahn S, et al. Outbreaks in neonatal intensive care units – they are not like others. Am J Infect Control. 2007;3:172-6.

  27. Warnes SL, Highmore CJ, Keevil CW. Horizontal transfer of antibiotic resistance genes on abiotic touch surfaces: implications for public health. MBio. 2012;3:e00489-12.




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