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2018, Number 4

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Enf Infec Microbiol 2018; 38 (4)

Intestinal colonization in newborns referred to a third-level care hospital

Góngora MMA, Cruz GÉ, Miranda NMG

Language: Spanish
References: 40
Page: 115-122
PDF size: 265.06 Kb.


ABSTRACT

Objectives. To establish the frequency of intestinal colonization in patients referred to nicu, with more than seven days of previous hospital stay, colonized by producing-ESBL enterobacterias.
Material and methods. Design cross-sectional survey. It was performed in a tertiary-care center. Neonatal intensive care unit have 24 beds. Non-probabilistic sample of consecutive cases, admitted to the NICU with previous hospital stay of at least seven days were included. Demographic data were obtained. A fecal sample was obtained from all patients by rectal hisope, at the admission and seven days alter, for those who remained in the NICU a third simple were also obtained. Samples were plated on agar Mueller- Hinton and MacConkey. To all growth bacteria on agar MacConkey were performed Gram-stain; identification and susceptibility were done by automatized system Vitek 2 (Phoenix, bioMérieux). Statistical analysis: descriptive statistics, and square-chi.
Results. 50 patients were included, to all a first sample was taken, a second one was obtained for 34 and a third for only in five. 64% had previous antimicrobial use history in their referral hospital. 68% was colonized in the first sample, nine patients with more than one enterobacteria. 60% of the isolated enterobacteria were esbls producers. In the second sample 13/34 patients had a positive culture for enterobacteriaceae. There was no statistical difference for those patients with antimicrobial use and a positive culture for esbls producers in comparison with those with a negative culture (p = 0.57). The most frequent enterobacteria isolated were: Klebsiella pneumoniae, Escherichia coli y Enterobacter spp.
Conclusions. Intestinal colonization with enterobacterias is high in patients referred to the NICU. ESBLS producers is 60%. Klebsiella pneumoniae was the most frequently isolated enterobacteria.


REFERENCES

  1. Mata, L.J. y Urrutia, J.J., “Intestinal colonization of breastfed children in a rural area of low socio-economic level”, Ann N Y Acad Sci, 1971, 176: 93-109.

  2. Stark, P.L. y Lee, A., “The microbial ecology of the large bowel of breast-fed and formula-fed infants during the first year of life”, J Med Microbiol, 1982, 15: 189-203.

  3. Gronlund, M.M., Lehtonen, O.P., Eerola, E. y Kero, P., “Fecal microflora in healthy infants born by different methods of delivery: permanent changes in intestinal flora after cesarean delivery”, J Pediatr Gastroenterol Nutr, 1999, 28: 19-25.

  4. Bennet, R. y Nord, C.E., “Development of the faecal anaerobic microflora after caesarean section and treatment with antibiotics in newborn infants”, Infection, 1987, 15: 332-336.

  5. Fryklund, B., Tullus, K., Berglund, B. y Burman, L.G., “Importance of the environment and the faecal flora of infants, nursing staff and parents as sources of gramnegative bacteria colonizing newborns in three neonatal wards”, Infection, 1992, 20: 253-257.

  6. Tannock, G.W., Fuller, R., Smith, S.L. y Hall, M.A., “Plasmid profiling of members of the family Enterobacteriaceae, lactobacilli, and bifidobacteria to study the transmission of bacteria from mother to infant”, J Clin Microbiol, 1990, 28: 1225-1228.

  7. Adlerberth, I., Carlsson, B., De Man, P., Jalil, F., Khan, S.R., Larsson, P., Mellander, L., Svanborg, C., Wold, A.E. y Hanson, L.Å., “Intestinal colonization with enterobacteriaceae in Pakistani and Swedish hospital-delivered infants”, Acta Paediatr Scand, 1991, 80: 602-610.

  8. Bennet, R., Eriksson, M., Nord, C.E. y Zetterstrom, R., “Fecal bacterial microflora of newborn infants during intensive care management and treatment with five antibiotic regimens”, Pediatr Infect Dis, 1986, 5: 533-539.

  9. Kafarskaia, L.I., Volodin, N.N., Efimov, B.A., Afanasev, S.S. y Shkoporov, A.N., “Peculiarities of microbial colonization of the intestinal tract in newborns and pre-term infants in intensive care units”, Vestnik Rossiiskoi Akademii Meditsinskikh Nauk, 2006, (1): 10-15.

  10. Fanaro, S., Chierici, R., Guerrini, P. y Vigi, V., “Intestinal microflora in early infancy: composition and development”, Acta Paediatrica Supp, 2003, 91 (441): 48-55.

  11. Donskey, C.J., “The role of de intestinal tract as a reservoir and source for transmission of nosocomial pathogens”, cid, 2004, 39: 219-226.

  12. Nowakowoska, M., Zientara, R.M., Maruniak-Chudek, I., Swietliski, M.G. y Radosz-Komoniewska, H., “Intestinal colonization of newborn treated in intensive care units by multiple drug resistant microorganisms”, Medycyna Doswiadczalna I Mikrobiologia, 2004, 56: 301-308.

  13. Boo, N.Y., Ng, S.F. y Lim, V.K., “A case control study of risk factors associated with rectal colonization of extended spectrum beta-lactamase producing Klebsiella sp. in newborn infants”, J Hosp Inf, 2005, 61: 68-74.

  14. Duman, N., Abacioglu, H., Karaman, M., Duman, N. y Ozkan, H., “Beta-lactam antibiotic resistance in aerobic commensal fecal flora of newborns”, Pediatr Int, 2005, 47: 267-273.

  15. Peña, C., Pujo, M., Ricart, A., Ardanuy, C., Ayats, J., Linares, J. y Garriosa, F., “Risk factors for faecal carriage of Klebsiella pneumoniae producing extended spectrum beta-lactamase (esbl-kp) in intensive care unit”, J Hosp Infect, 1997, 35: 9-16.

  16. Franiczek, R., Sobieszczanska, B., Grabowski, M., Mowszet, K. y Pytrus, T., “Occurrence of extended-spectrum beta-lactamases among Escherichia coli isolates from hospitalized and healthy children”, Folia Microbiol, 2003; 48: 243-247.

  17. Valenzuela Flores, A., Solórzano Santos, F y Miranda, G., “Utilidad de la electroforesis de campos pulsados para analizar cepas de Klebsiella pneumoniae multirresistente”, Tesis de Maestría en Ciencias Médicas, Facultad de Medicina, unam, 2001.

  18. Miranda, G., Castro, N., Leaños, B., Solórzano, F. y Siva, J., “Clonal and horizontal dissemination of Klebsiella pneumoniae expressing shv-5 extended-spectrum b-lactamase in Mexican pediatric hospital”, J Clin Microbiol, 2004, 42: 30-34.

  19. Meyer, K.S., Urban, C., Eagan, J.A., Berger, B.J. y Rahal, J.J., “Nosocomial outbreak of Klebsiella pneumoniae resistant to late-generation cephalosporins”, Ann Intern Med, 1993, 119: 353-358.

  20. Bosi, C., David-Regli, A., Bornet, C., Mallea, M. Pages, J. y Bollet, C., “Most Enterobacter aerogenes strains in France belong to a prevalent clone”, J Clin Microbiol, 1999, 37: 2165-2169.

  21. Drusano, G.L., “Infection in the intensive Care Unit: beta-lactamase-mediated resistance among enterobacteriaceae and optimal antimicrobial dosing”, cid, 1998, 27: S111-116.

  22. Silva, J., Aguilar, C. y Estrada, M.A., “Susceptibility to new beta-lactams of enterobacteria extended-spectrum beta-lactamase (esbl) producers and penicillin-resistant Streptococcus pneumoniae in Mexico”, J Chemother, 1998, 10: 102-107.

  23. Alcántar-Curiel, D., Tinoco, J.C., Gayosso, C., Daza, A., Pérez-Prado, M.C., Salcido, L., Santos, J.I. y Alpuche- Aranda, C.M., “Nosocomial bacteremia and urinary tract infections caused by extended-spectrum beta-lactamase producing Klebsiella pneumoniae with plasmids carrying both shv-5 and tla-1 genes”, cid, 2004; 38:1067-1074.

  24. Miranda, G., Castro, N., Leaños, B., Solórzano, F. y Siva, J., “Clonal and horizontal dissemination of Klebsiella pneumoniae expressing shv-5 extended-spectrum b-lactamase in Mexican pediatric hospital”, J Clin Microbiol, 2004, 42: 30-34.

  25. Alcántar-Curiel, M.D., Daza, C., Tinoco, J.C., Morfin, R., Solórzano, S.F., Rodríguez, E., Miranda, G., Gayosso, C., Santos, J.I. y Alpuche, A.C., “Alta frecuencia de Klebsiella pneumoniae nosocomiales productoras de b-lactamasa de espectro extendido (blees) en instituciones mexicanas asociadas a diseminación clonal y horizontal de plásmidos conjugativos”, Resumen, IX Congreso Panamericano de Infectología, Córdoba, Argentina, mayo de 2003.

  26. Peregrino, L. y Miranda, M.G., “Características clínicas de la infección nosocomial por Klebsiella pneumoniae productoras y no productoras de beta lactamasa de espectro extendido (blees). Factores asociados a falla terapéutica en pacientes pediátricos con infección por K. pneumoniae”, Tesis en Infectología Pediátrica, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, imss, 2003.

  27. Registros del Laboratorio Clínico, Sección de Microbiología, umae, Hospital de Pediatría, 2004-2006.

  28. Huerta, G.G., Fortino, S.S. y Miranda, N.G., “Prevalencia de colonización gastrointestinal por enterobacterias productoras de beta-lactamasas de espectro extendido (blees) en población pediátrica hospitalizada en unidades de segundo nivel de atención del Instituto Mexicano del Seguro Social”, Tesis en Infectología Pediátrica, 2005.

  29. Cruz, G.E. y Miranda, N.G., “Impacto de la disminución del uso de ceftazdima en la frecuencia de infecciones beta-lactamasas de espectro extendido (blees) en enterobacterias”, Tesis en Pediatría, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, 2005.

  30. Clinical and Laboratory Standards Institute (clsi), “Performance standards for antimicrobial susceptibility testing. Fifteenth Informational Supplement, clsi document M100-S15, Pennsylvania, 19087-19098, 2005.

  31. Tolzis, P., Dul, M.J., Hoyen, C., Salvator, A. et al., “Molecular epidemiology of antibiotic-resistant gram-negative bacilli in a neonatal intensive care unit during a non-outbreak period”, Pediatrics, 2004, 108: 1143-1148.

  32. Tolzis, P., Hoyen, C., Block, S.S. et al., “Factors that predict preexisting colonization with antibiotic resistant gram negative bacilli in patients admitted to a pediatric intensive care unit”, Pediatrics, 1999, 103: 719-723.

  33. Leonard, M.E., Van Saene, H.K. y Sears, P., “Pathogenesis of colonization and infection in a neonatal surgical unit”, Crit Care Med, 1990, 18: 264-269.

  34. Goldman, D.A., Leclair, J. y Macone, A., “Bacterial colonization of neonates admitted to an intensive care environment”, J Pediatr, 1978, 93: 288-293.

  35. Dent, A. y Toltzi, P., “Descriptive and molecular epidemiology of gram negative bacilli infections in the neonatal intensive care unit”, Curr Opin Infect Dis, 2003, 16: 279- 283.

  36. Gniadkowiski, M., “Evolution and epidemiology of extended-spectrum beta-lactamases (esbls) and esblproducing microorganisms”, Clin Microbiol Infect, 2001, 7: 597-608.

  37. Lucet, J.C. y Regnier, B., “Enterobacteria producing extended spectrum b-lactamase”, Pathol Biol, 1998, 46: 235-243.

  38. Decre, D., Gachot, B. y Lucet, J.C., “Clinical and bacteriologic epidemiology of extended-spectrum beta-lactamase- producing strains of Klebsiella pneumoniae in medical intensive care unit”, cid, 1998, 27: 834-844.

  39. Cormican, M., Marshall, S. y Jones, R., “Detection of extended-spectrum b-lactamase (esbl)-producing strains by the E-test esbl Screen”, jcm, 1996, 34: 1880-1884.

  40. Petros, A.J., O’Connell, M., Roberts, C., Wade, P. y Van Saene, H.K., “Systemic antibiotics fail to clear multidrugresistant Klebsiella from a Pediatric icu”, Chest, 2001, 119: 862-866.




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