Rates of Fecal Transmission of Extended-Spectrum beta-Lactamase-Producing and Carbapenem-Resistant Enterobacteriaceae Among Patients in Intensive Care Units in Korea.
- Author:
Jayoung KIM
1
;
Ji Young LEE
;
Sang Il KIM
;
Wonkeun SONG
;
Jae Seok KIM
;
Seungwon JUNG
;
Jin Kyung YU
;
Kang Gyun PARK
;
Yeon Joon PARK
Author Information
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords: Rectal swab; Colonization; Transmission; ESBL-E; CRE; CTX-M
- MeSH: Anti-Bacterial Agents/pharmacology; Bacterial Proteins/*metabolism; Carbapenems/*pharmacology; Carrier State/epidemiology; Cross Infection/epidemiology/*transmission; DNA, Bacterial/analysis; Drug Resistance, Bacterial/drug effects; Electrophoresis, Gel, Pulsed-Field; Enterobacteriaceae/enzymology/genetics/*physiology; Enterobacteriaceae Infections/epidemiology/*transmission; Feces/*microbiology; Genotype; Humans; Intensive Care Units; Polymerase Chain Reaction; Prevalence; Republic of Korea/epidemiology; beta-Lactamases/*metabolism
- From:Annals of Laboratory Medicine 2014;34(1):20-25
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND: We investigated the rates of fecal transmission of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) and carbapenem-resistant Enterobacteriaceae (CRE) among patients admitted to intensive care units (ICUs). METHODS: From June to August 2012, rectal cultures were acquired from all patients at ICU admission. For patients not carrying ESBL-E or CRE at admission, follow-up cultures were performed to detect acquisition. A chromogenic assay was used to screen for ESBL-E and CRE. Bacterial species identification and antibiotic susceptibility tests were performed using the Vitek 2 system (bioMerieux, France). ESBL genotypes were determined by PCR, and clonal relatedness of the isolates was assessed by pulsed-field gel electrophoresis. RESULTS: Out of 347 ICU admissions, 98 patients were found to be carriers of ESBL-E (28.2%, 98/347). Follow-up cultures were acquired from 91 of the patients who tested negative for ESBL-E at admission; the acquisition rate in this group was 12.1% (11/91), although none was a nosocomial transmission. For CRE, the prevalence of fecal carriage was 0.3% (1/347), and the acquisition rate was 2.9% (4/140). None of the CRE isolates were carbapenemase-producers. CONCLUSIONS: The high prevalence of ESBL-E carriage on admission (28.2%), coupled with rare nosocomial transmission and the very low carriage rate of CRE (0.3%), challenge the routine use of active surveillance in non-epidemic settings. Nevertheless, passive surveillance measures, such as rapid and accurate screening of clinical specimens, will be critical for controlling the spread of CRE.
