1.Rates of Fecal Transmission of Extended-Spectrum beta-Lactamase-Producing and Carbapenem-Resistant Enterobacteriaceae Among Patients in Intensive Care Units in Korea.
Jayoung KIM ; Ji Young LEE ; Sang Il KIM ; Wonkeun SONG ; Jae Seok KIM ; Seungwon JUNG ; Jin Kyung YU ; Kang Gyun PARK ; Yeon Joon PARK
Annals of Laboratory Medicine 2014;34(1):20-25
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.
Anti-Bacterial Agents/pharmacology
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Bacterial Proteins/*metabolism
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Carbapenems/*pharmacology
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Carrier State/epidemiology
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Cross Infection/epidemiology/*transmission
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DNA, Bacterial/analysis
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Drug Resistance, Bacterial/drug effects
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Electrophoresis, Gel, Pulsed-Field
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Enterobacteriaceae/enzymology/genetics/*physiology
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Enterobacteriaceae Infections/epidemiology/*transmission
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Feces/*microbiology
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Genotype
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Humans
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Intensive Care Units
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Polymerase Chain Reaction
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Prevalence
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Republic of Korea/epidemiology
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beta-Lactamases/*metabolism