1
|
Eddair Y, Belouad E, Benaissa E, Abassor T, Bsaibiss F, Maleb A, Elouennass M. Phenotypic and genotypic characterization of extended-spectrum beta-lactamase-producing Enterobacteriaceae in a Moroccan hospital. Access Microbiol 2024; 6:000822.v3. [PMID: 39070755 PMCID: PMC11282464 DOI: 10.1099/acmi.0.000822.v3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/05/2024] [Indexed: 07/30/2024] Open
Abstract
Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) is a major public health problem in hospitals and in the community. The objective of this work was to describe the epidemiology of ESBL-E, to study their resistance profile and to determine the genes encoding the ESBL phenotype. This is a retrospective study conducted in the bacteriology laboratory of the Mohamed V Military Training Hospital in Rabat, and covering all isolates of Enterobacteriaceae from 1 January 2018 to 31 December 2020. The molecular study of ESBL genes involved a representative sample of all ESBL isolates. The overall prevalence of ESBLs in isolated Enterobacteriaceae (1402/10268) is 13.65 %. The urinary tract was the main site of isolation of ESBL (61 %). The bacterial species most concerned are Escherichia coli (41.9 %), Klebsiella pneumoniae (42.2 %) and Enterobacter cloacae (11.9 %). The study of antibiotic susceptibility showed a resistant profile marked mainly by 100 % resistance to first generation cephalosporins (1GC) and third generation cephalosporins (3GC), 55 % to piperacillin-tazobactam, 16 % to imipenem, and 87 % to fluoroquinolones. Molecular typing of ESBL strains showed a prevalence of CTX-M (95 %), SHV (50 %) and TEM (56 %). The CTX-M-1 and the CTX-M-9 groups were the most common (96.19 % and 7.62 % respectively), and CTX-M15 was found in 78.10 % of CTX-M-1 ESBL positive isolates. Most strains had more than two coexisting resistance genes. The prevalence rate of ESBL-E is critical, and preventive action at different levels (prescriber, biologist, hospital, patient, etc.) are necessary in order to limit their spread and to manage a better therapeutic strategy.
Collapse
Affiliation(s)
- Yassine Eddair
- Laboratory of Bacteriology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Elmehdi Belouad
- Laboratory of Bacteriology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Elmostafa Benaissa
- Laboratory of Bacteriology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
- Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Tilila Abassor
- Laboratory of Bacteriology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Fatna Bsaibiss
- Laboratory of Bacteriology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Adil Maleb
- Laboratory of Microbiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, University Mohammed the First, Oujda, Morocco
| | - Mostafa Elouennass
- Laboratory of Bacteriology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
- Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| |
Collapse
|
2
|
Akinduti PA, Olasehinde GI, Ejilude O, Taiwo OS, Obafemi YD. Fecal carriage and phylodiversity of community-acquired bla TEM Enteric bacilli in Southwest Nigeria. Infect Drug Resist 2018; 11:2425-2433. [PMID: 30568469 PMCID: PMC6267359 DOI: 10.2147/idr.s178243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Increasing rates of clonal spread of fecal blaTEM bacilli remains a huge concern to the community health with resultant high morbidity. The fecal carriage and clonal diversity of blaTEM within the communities in Southwest Nigeria were surveyed. Materials and methods Enteric bacilli obtained from fresh fecal samples randomly collected from community residents were biotyped and profiled for antibiotic susceptibility. Resistant strains were typed for beta-lactamase, extended-spectrum beta-lactamases (ESBL), AmpC and carbapenemase production while the R-plasmid carriage was detected and mating activities were examined. The presence of blaTEM gene was assayed by PCR and its phylodiversity determined with 16sRNA genomic profiling. Results Escherichia coli have the highest (28.6%) occurrence rate and Pseudomonas aeruginosa (20.5%) showing significant resistance to beta-lactamase inhibitors (ampicillin, cefuroxime and cefotaxime), and high-level multidrug resistance of more than 15.2% rate to ampicillin, cefuroxime, ceftazidime, tetracycline and imipenem. E. coli and Klebsiella oxytoca, are the highest beta-lactamase, ESBL and AmpC producers encoded with high molecular weight R-plasmid (>11.0 kbp) and significant rate of conjugation and transformational activities. Only 2/14, 1/13 and 1/6 ESBL-type of E. coli, K. oxytoca and Enterobacter cloaca, expressed blaTEM gene, clustering into five different phylodiverse groups with close genomic relatedness with other bacilli. Conclusion This is an indication of clonal dissemination of ESBL blaTEM encoded enteric bacilli having high phylodiverse characteristics through fecal carriage in the Nigerian community which requires public health education, food and environmental hygiene for its prevention.
Collapse
Affiliation(s)
- Paul Akinniyi Akinduti
- Microbiology Unit, Department of Biological Sciences, Covenant University, Otta, Nigeria,
| | - Grace Iyabo Olasehinde
- Microbiology Unit, Department of Biological Sciences, Covenant University, Otta, Nigeria,
| | - Oluwaseun Ejilude
- Microbiology Unit, Sacred Heart Hospital, Lantoro, Abeokuta, Nigeria
| | - Olugbenga Samson Taiwo
- Microbiology Unit, Department of Biological Sciences, Covenant University, Otta, Nigeria,
| | - Yemisi Dorcas Obafemi
- Microbiology Unit, Department of Biological Sciences, Covenant University, Otta, Nigeria,
| |
Collapse
|
3
|
Pilmis B, Cattoir V, Lecointe D, Limelette A, Grall I, Mizrahi A, Marcade G, Poilane I, Guillard T, Bourgeois Nicolaos N, Zahar JR, Le Monnier A. Carriage of ESBL-producing Enterobacteriaceae in French hospitals: the PORTABLSE study. J Hosp Infect 2017; 98:247-252. [PMID: 29222035 DOI: 10.1016/j.jhin.2017.11.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Currently, contact precautions are recommended for patients colonized or infected with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). Recent studies have challenged this strategy. This study aimed to assess the rate of ESBL-PE faecal carriage among hospitalized patients according to type of hospital ward, and to identify risk factors associated with carriage. METHODS A point prevalence study was conducted in five different types of hospital ward [medical, surgical, intensive care unit (ICU), after care and rehabilitation, and geriatric] in eight French hospitals. All patients included in the study provided a fresh stool sample. RESULTS In total, 554 patients were included in the study, with a median age of 73 years (range 60-82 years). The overall faecal carriage rate of ESBL-PE was 17.7%. The most frequently encountered species among ESBL-PE was Escherichia coli (71.4%), followed by Klebsiella pneumoniae (14.3%). Risk factors associated with ESBL-PE faecal carriage on univariate analysis were: living in the Paris region (P<0.01) and hospitalization on a geriatric ward (P<0.01). Interestingly, the cumulative duration of hospital stay before screening was not associated with a significantly higher prevalence of ESBL-PE carriage, regardless of ward type. The ESBL-PE colonization rate was much higher for patients hospitalized on geriatric wards (28.1%) and ICUs (21.7%) compared with those for patients hospitalized on surgical wards (14.8%), medical wards (12.8%) or aftercare and rehabilitation (11.2%). CONCLUSION The overall prevalence of ESBL-PE faecal carriage was 17.7%, with only 21% of patients identified previously as carriers. The delay between admission and screening was not associated with an increase in ESBL-PE faecal carriage.
Collapse
Affiliation(s)
- B Pilmis
- Equipe Mobile de Microbiologie clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - V Cattoir
- Laboratoire de Microbiologie, CHU de Caen, Caen, France
| | - D Lecointe
- Unité Fonctionnelle d'Hygiène Hospitalière et de Lutte contre les Infections Nosocomiales, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - A Limelette
- Laboratoire de Bactériologie-Virologie-Hygiène, CHU Reims, Hôpital Robert Debré, UFR de Médecine, EA4687, Université de Reims Champagne-Ardenne Reims, France
| | - I Grall
- Clinique de Champigny, Champigny sur Marne, France
| | - A Mizrahi
- Laboratoire de Microbiologie clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France; EA4043 Unité Bactéries pathogènes et Santé (UBaPS), Université Paris-Sud, Paris Saclay, Chatenay-Malabry, France
| | - G Marcade
- Laboratoire de Microbiologie, Hôpital Louis Mourier, Colombes, France
| | - I Poilane
- Laboratoire de Microbiologie, Hôpital Jean Verdier, Bondy, France
| | - T Guillard
- Laboratoire de Bactériologie-Virologie-Hygiène, CHU Reims, Hôpital Robert Debré, UFR de Médecine, EA4687, Université de Reims Champagne-Ardenne Reims, France
| | - N Bourgeois Nicolaos
- EA4043 Unité Bactéries pathogènes et Santé (UBaPS), Université Paris-Sud, Paris Saclay, Chatenay-Malabry, France; Service de Bactériologie et hygiène, Hôpital Antoine Béclère, Clamart, France
| | - J-R Zahar
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, Département de Microbiologie Clinique, Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, CHU Avicenne, Bobigny, France.
| | - A Le Monnier
- Laboratoire de Microbiologie clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France; EA4043 Unité Bactéries pathogènes et Santé (UBaPS), Université Paris-Sud, Paris Saclay, Chatenay-Malabry, France
| |
Collapse
|
4
|
Mittal G, Gaind R, Kumar D, Kaushik G, Gupta KB, Verma PK, Deb M. Risk factors for fecal carriage of carbapenemase producing Enterobacteriaceae among intensive care unit patients from a tertiary care center in India. BMC Microbiol 2016; 16:138. [PMID: 27392139 PMCID: PMC4938945 DOI: 10.1186/s12866-016-0763-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Resistance amongst the commensal flora is a serious threat because a very highly populated ecosystem like the gut, may at a later stage, be a source of extra intestinal infections, resistant strains may spread to other host or transfer genetic resistance element to other members of micro-biota including pathogens. This study was carried out to assess fecal colonization by carbapenemase producing Enterobacteriaceae (CPE) and associated risk factors among 100 patients admitted to intensive care unit (ICU). The phenotypic and molecular characterizations of CPE were also included. RESULTS Colonization with CPE was observed in 6.6 % (8/122) controls. Among ICU patients, fecal carriage of CPE was significantly higher on day 4 (D4) (22 %) as compared to day 1 (D1) (11 %) (p value 0.002). The carbapenemase genes detected included OXA- 48, 181, KPC and NDM-1 with NDM-1 being the predominant carbapenemase in both ICU D1 and D4. Among the 50 CPE isolates, 8 (16 %) were susceptible to meropenem and imipenem (Minimum inhibitory concentration; MIC ≤ 1 mg/L) and all were susceptible to colistin (MIC range 0.125 - 1 mg/L) and tigecycline (MIC range 0.06- 1.5 mg/L). The risk factors associated with CPE carriage were duration of ICU stay, use of ventilator and aminoglycosides. CONCLUSIONS Prior colonization with CPE could result in their influx and spread in ICU, challenging infection control measures. Exposure to ICU further increases risk of colonization with diverse carbapenemase-producing Enterobacteriaceae. Gut colonization with these strains may be a source of endogenous infection and horizontal transfer of these genes in future.
Collapse
Affiliation(s)
- Gajanand Mittal
- Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, 110029, India
| | - Rajni Gaind
- Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, 110029, India.
| | - Deepak Kumar
- Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, 110029, India
| | - Gaurav Kaushik
- Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, 110029, India
| | - Kunj Bihari Gupta
- Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, 110029, India
| | - P K Verma
- Department of Anaesthesia, VMMC and Safdarjung Hospital, New Delhi, 110029, India
| | - Monorama Deb
- Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, 110029, India
| |
Collapse
|
5
|
Nakai H, Hagihara M, Kato H, Hirai J, Nishiyama N, Koizumi Y, Sakanashi D, Suematsu H, Yamagishi Y, Mikamo H. Prevalence and risk factors of infections caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. J Infect Chemother 2016; 22:319-26. [PMID: 26968486 DOI: 10.1016/j.jiac.2016.02.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/05/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To study the clinical characteristics and associated risk factors of infections caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. METHODS A case-control study at a large university hospital in Japan, comparing patients who were infected or colonized with ESBL-producing Enterobacteriaceae (n = 212) and non-ESBL-producing Enterobacteriaceae (n = 2089) in 2010-2013. Data were collected from medical charts, retrospectively. Multivariate logistic regression analysis was used to explore risk factors of ESBL-producing Enterobacteriaceae (Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Proteus mirabilis) infection or colonization for each pathogen, respectively. RESULTS ESBL-producing Enterobacteriaceae [E. coli (n = 113), K. oxytoca (n = 46), K. pneumoniae (n = 41), P. mirabilis (n = 12)] were taken from patients were identified in 1409 outpatient and 892 inpatients. Infection or colonization caused by ESBL-producing Enterobacteriaceae was considered to be hospital-acquired, healthcare-associated and community-acquired in 60.4%, 17.9% and 21.7% patients, respectively. Independent risk factors for ESBL-producing Enterobacteriaceae infection or colonization were male sex, cerebrovascular disease, intubation/tracheostomy, major surgery within 60 days (p < 0.001). Moreover, antimicrobial usage (more than 4 days) during preceding 60 days, especially aminoglycoside, oxazolidinone, tetracycline, fluoroquinolone, trimethoprim/sulfamethoxazole, and second- and fourth-generation cephalosporin were risk factors (p < 0.001). However, acquisition location of infection (hospital-acquired and community-onset) was not a risk factor (p > 0.05). CONCLUSION The problem of ESBL production is no longer limited to hospital-acquired infections. The presence of chronic illness, such as cerebrovascular disease, and recent antimicrobial use were independent risk factors for ESBL-producing Enterobacteriaceae infection or colonization.
Collapse
Affiliation(s)
- Hazuki Nakai
- Department of Clinical Infectious Diseases, Aichi Medical University Graduate School of Medicine, Japan
| | - Mao Hagihara
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan; Department of Pharmacy, Aichi Medical University Hospital, Japan
| | - Hideo Kato
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan; Department of Pharmacy, Aichi Medical University Hospital, Japan
| | - Jun Hirai
- Department of Clinical Infectious Diseases, Aichi Medical University Graduate School of Medicine, Japan
| | - Naoya Nishiyama
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Yusuke Koizumi
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Daisuke Sakanashi
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hiroyuki Suematsu
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Yuka Yamagishi
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Graduate School of Medicine, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
| |
Collapse
|
6
|
Epidemiology of third-generation cephalosporin-resistant community-acquired Enterobacteria isolated from elderly patients. Med Mal Infect 2014; 44:57-62. [PMID: 24556454 DOI: 10.1016/j.medmal.2013.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/27/2013] [Accepted: 11/18/2013] [Indexed: 11/21/2022]
Abstract
AIMS This survey was made to study the epidemiology of multiresistant bacteria (MRB) in the French community, among elderly patients 65 years of age or more, carrying third-generation cephalosporin-resistant (3GC-resistant) Enterobacteriaceae, and the co-resistance of prescribed antibiotics. METHODS The data was collected in 2009 in the West of France by MedQual, a network of 174 private laboratories. RESULTS Two thousand one hundred and sixty strains of the 88,255 identified Enterobacteria strains were 3GC-resistant (2.4%) and 945 of these strains (41.8%) were isolated from elderly patients 65 years of age or more. Escherichia coli was the predominant 3GC-resistant strain (72.7%). 51.4% of the 945 patients in whom a 3GC-resistant strain was isolated produced an extended-spectrum β-lactamase (ESBL). The main risk factors for infection with the 3GC-resistant strain were hospitalization and antibiotic treatment in the previous year (58.2 and 86.9%, respectively). Hospitalization during the previous year was more frequent among elderly patients who lived at home compared with those who lived in nursing homes (P<0.05). The production of ESBL, among the 945 patients who carried the 3GC-resistant strains, was similar among patients who lived at home compared with those who lived in nursing homes (51.4% versus 49.7%). CONCLUSION Microbiologists should warn family physicians about MRB isolates with a specific antimicrobial resistance pattern (3GC-resistant, fluoroquinolone-resistant, etc.) to prescribe more effective medications.
Collapse
|
7
|
Screening at admission for carrier prevalence of multidrug-resistant organisms in a pediatric unit. Am J Infect Control 2014; 42:88-9. [PMID: 24388477 DOI: 10.1016/j.ajic.2013.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 07/09/2013] [Indexed: 11/24/2022]
|
8
|
Kothari C, Gaind R, Singh LC, Sinha A, Kumari V, Arya S, Chellani H, Saxena S, Deb M. Community acquisition of β-lactamase producing Enterobacteriaceae in neonatal gut. BMC Microbiol 2013; 13:136. [PMID: 23773627 PMCID: PMC3689095 DOI: 10.1186/1471-2180-13-136] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 06/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Commensal flora constitutes a reservoir of antibiotic resistance. The increasing variety of β-lactamases and the emergence of Carbapenem resistant Enterobacteriaceae (CRE) in community, raise concerns regarding efficacy of β-lactams. It is important to know the exact load of antibiotic resistance in the absence of any antibiotic selection pressure including via food and water.In the present study gut colonization in neonates with no direct antibiotic pressure was used as a model to evaluate β-lactam resistance in the community. RESULTS In this prospective study, 75 healthy, vaginally delivered, antibiotic naive, breast fed neonates were studied for gut colonization by Extended spectrum β-lactamases (ESBL), AmpC β-lactamases hyperproducing Enterobacteriaceae and CRE on day 0, 21 and 60. Total 267 Enterobacteriaceae were isolated and E.coli was the predominant flora. ESBL, AmpC and coproduction was seen in 20.6%, 19.9% and 11.2% isolates respectively. ESBL carriage increased threefold from day 1 to 60 showing predominance of CTX-M group 15 (82.5%), ampC genes were heterogeneous. Colonization with CRE was rare, only one baby harboured Enterobacter sp positive for kpc-2. The reservoirs for these genes are likely to be mother and the environment. CONCLUSIONS Data strongly suggests that in absence of any antibiotic pressure there is tremendous load of antibiotic resistance to β-lactam drugs. Wide spread presence of ESBL and AmpC can drive rapid emergence and dissemination of CRE. This is the first report from India which depicts the smaller picture of true antibiotic pressure present in the Indian community.
Collapse
Affiliation(s)
- Charu Kothari
- Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi 110029, India
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Schoevaerdts D, Bogaerts P, Grimmelprez A, de Saint-Hubert M, Delaere B, Jamart J, Swine C, Glupczynski Y. Clinical profiles of patients colonized or infected with extended-spectrum beta-lactamase producing Enterobacteriaceae isolates: a 20 month retrospective study at a Belgian University Hospital. BMC Infect Dis 2011; 11:12. [PMID: 21226923 PMCID: PMC3023698 DOI: 10.1186/1471-2334-11-12] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 01/12/2011] [Indexed: 11/26/2022] Open
Abstract
Background Description of the clinical pictures of patients colonized or infected by ESBL-producing Enterobacteriaceae isolates and admitted to hospital are rather scarce in Europe. However, a better delineation of the clinical patterns associated with the carriage of ESBL-producing isolates may allow healthcare providers to identify more rapidly at risk patients. This matter is of particular concern because of the growing proportion of ESBL-producing Enterobacteriaceae species isolates worldwide. Methods We undertook a descriptive analysis of 114 consecutive patients in whom ESBL-producing Enterobacteriaceae isolates were collected from clinical specimens over a 20-month period. Clinical data were obtained through retrospective analysis of medical record charts. Microbiological cultures were carried out by standard laboratory methods. Results The proportion of ESBL-producing Enterobacteriaceae strains after exclusion of duplicate isolates was 4.5% and the incidence rate was 4.3 cases/1000 patients admitted. Healthcare-associated acquisition was important (n = 104) while community-acquisition was less frequently found (n = 10). Among the former group, two-thirds of the patients were aged over 65 years and 24% of these were living in nursing homes. Sixty-eight (65%) of the patients with healthcare-associated ESBL, were considered clinically infected. In this group, the number and severity of co-morbidities was high, particularly including diabetes mellitus and chronic renal insufficiency. Other known risk factors for ESBL colonization or infection such as prior antibiotic exposure, urinary catheter or previous hospitalisation were also often found. The four main diagnostic categories were: urinary tract infections, lower respiratory tract infections, septicaemia and intra-abdominal infections. For hospitalized patients, the median hospital length of stay was 23 days and the average mortality rate during hospitalization was 13% (Confidence Interval 95%: 7-19). Escherichia coli, by far, accounted as the most common ESBL-producing Enterobacteriaceae species (77/114; [68%]) while CTX-M-1 group was by far the most prevalent ESBL enzyme (n = 56). Conclusion In this retrospective study, the clinical profiles of patients carrying healthcare-associated ESBL-producing Enterobacteriacae is characterized by a high prevalence rate of several major co-morbidities and potential known risk factors. Both, the length of hospital stay and overall hospital mortality rates were particularly high. A prospective case-control matched study should be designed and performed in order to control for possible inclusion bias.
Collapse
Affiliation(s)
- Didier Schoevaerdts
- Department of Geriatric Medicine, Cliniques Universitaires UCL de Mont-Godinne, 5530 Yvoir, Belgium.
| | | | | | | | | | | | | | | |
Collapse
|