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Prevalence of urinary colonization by extended spectrum-beta-lactamase Enterobacteriaceae among catheterised inpatients in Italian long term care facilities.
BMC Infect Dis. 2013 Mar 06; 13:124.BI

Abstract

BACKGROUND

Long Term Care Facilities (LTCFs) play a key role in guaranteeing care to patients in developed countries. Many patients, mostly elderly, access LTCFs at some time in their lives, and their healthcare pathways often require them to move back and forth between hospital and outpatient settings. These patterns bring about new challenges regarding infection control, especially healthcare associated infections.

METHODS

A point prevalence study was conducted in 23 Italian LTCFs, to identify colonization in patients with urinary catheter (>24 hours). Species identification, susceptibility tests and extended spectrum beta lactamase (ESBL) production screenings were performed using Vitek 2 System. Enterobacteria identified by Vitek 2 System as ESBL-producers or suspected AmpC hyperproducers on the basis of cephamycin resistance, were sent to a research laboratory where they underwent a double-disk synergy test. Finally, ESBL-producers were screened for bla resistance genes by PCR assay.

RESULTS

211 patients with catheter were screened, 185 out of 211 patients showed positive samples for the presence of Enterobacteriaceae, 114 of these 185 patients were colonized by extended spectrum cephalosporins resistant microorganisms. We identified a total of 257 Gram negative pathogens, of which 51.8% (133/257) were extended spectrum cephalosporins resistant. 7 out of 133 cephamycin not susceptible strains proved to be AmpC-type beta-lactamases and 125/133 ESBL-producers; 1 was not further characterized. 43 out of 257 (16.7%) E. coli, 37/257 (14.4%) P. mirabilis, 20/257 (7.8%), P. stuartii, 14/257 (5.4%) M. morganii, 7/257 (2.7%), K. pneumoniae, 4/257 (1.6%) C. koseri proved to be overall ESBL-producers by double-disk synergy test. Third and fourth generation cephalosporin resistant P. mirabilis, P. stuartii and M. morganii strains mainly harboured a blaTEM gene (95.9%), while 89.1% of E. coli were positive for the blaCTX-M determinant by PCR and sequencing. Patients with decubitus had a higher risk of colonization by at least one resistant isolate (p < 0.01). Samples of patients undergoing antibiotic therapy and patients with decubitus showed a higher risk (p < 0.05) of colonization by beta-lactam resistant microorganisms.

CONCLUSIONS

These data confirm the presence of high percentages of ESBL-positive Enterobacteria in Italian LTCFs and the predominance of CTX-M type ESBL in E. coli. The alarming presence of ESBL-producing Enterobacteriaceae in Italian LTCFs can seriously compromise the effectiveness of antibiotic therapy.acilities (LTCFs), Antimicrobial resistance.

Authors+Show Affiliations

Department of Medical and Biological Sciences, University of Udine, Udine, Italy. arnoldo.luca@libero.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23497323

Citation

Arnoldo, Luca, et al. "Prevalence of Urinary Colonization By Extended Spectrum-beta-lactamase Enterobacteriaceae Among Catheterised Inpatients in Italian Long Term Care Facilities." BMC Infectious Diseases, vol. 13, 2013, p. 124.
Arnoldo L, Migliavacca R, Regattin L, et al. Prevalence of urinary colonization by extended spectrum-beta-lactamase Enterobacteriaceae among catheterised inpatients in Italian long term care facilities. BMC Infect Dis. 2013;13:124.
Arnoldo, L., Migliavacca, R., Regattin, L., Raglio, A., Pagani, L., Nucleo, E., Spalla, M., Vailati, F., Agodi, A., Mosca, A., Zotti, C., Tardivo, S., Bianco, I., Rulli, A., Gualdi, P., Panetta, P., Pasini, C., Pedroni, M., & Brusaferro, S. (2013). Prevalence of urinary colonization by extended spectrum-beta-lactamase Enterobacteriaceae among catheterised inpatients in Italian long term care facilities. BMC Infectious Diseases, 13, 124. https://doi.org/10.1186/1471-2334-13-124
Arnoldo L, et al. Prevalence of Urinary Colonization By Extended Spectrum-beta-lactamase Enterobacteriaceae Among Catheterised Inpatients in Italian Long Term Care Facilities. BMC Infect Dis. 2013 Mar 6;13:124. PubMed PMID: 23497323.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence of urinary colonization by extended spectrum-beta-lactamase Enterobacteriaceae among catheterised inpatients in Italian long term care facilities. AU - Arnoldo,Luca, AU - Migliavacca,Roberta, AU - Regattin,Laura, AU - Raglio,Annibale, AU - Pagani,Laura, AU - Nucleo,Elisabetta, AU - Spalla,Melissa, AU - Vailati,Francesca, AU - Agodi,Antonella, AU - Mosca,Adriana, AU - Zotti,Carla, AU - Tardivo,Stefano, AU - Bianco,Ines, AU - Rulli,Adele, AU - Gualdi,Paola, AU - Panetta,Pietro, AU - Pasini,Carlo, AU - Pedroni,Mino, AU - Brusaferro,Silvio, Y1 - 2013/03/06/ PY - 2012/03/23/received PY - 2013/02/26/accepted PY - 2013/3/19/entrez PY - 2013/3/19/pubmed PY - 2014/1/8/medline SP - 124 EP - 124 JF - BMC infectious diseases JO - BMC Infect. Dis. VL - 13 N2 - BACKGROUND: Long Term Care Facilities (LTCFs) play a key role in guaranteeing care to patients in developed countries. Many patients, mostly elderly, access LTCFs at some time in their lives, and their healthcare pathways often require them to move back and forth between hospital and outpatient settings. These patterns bring about new challenges regarding infection control, especially healthcare associated infections. METHODS: A point prevalence study was conducted in 23 Italian LTCFs, to identify colonization in patients with urinary catheter (>24 hours). Species identification, susceptibility tests and extended spectrum beta lactamase (ESBL) production screenings were performed using Vitek 2 System. Enterobacteria identified by Vitek 2 System as ESBL-producers or suspected AmpC hyperproducers on the basis of cephamycin resistance, were sent to a research laboratory where they underwent a double-disk synergy test. Finally, ESBL-producers were screened for bla resistance genes by PCR assay. RESULTS: 211 patients with catheter were screened, 185 out of 211 patients showed positive samples for the presence of Enterobacteriaceae, 114 of these 185 patients were colonized by extended spectrum cephalosporins resistant microorganisms. We identified a total of 257 Gram negative pathogens, of which 51.8% (133/257) were extended spectrum cephalosporins resistant. 7 out of 133 cephamycin not susceptible strains proved to be AmpC-type beta-lactamases and 125/133 ESBL-producers; 1 was not further characterized. 43 out of 257 (16.7%) E. coli, 37/257 (14.4%) P. mirabilis, 20/257 (7.8%), P. stuartii, 14/257 (5.4%) M. morganii, 7/257 (2.7%), K. pneumoniae, 4/257 (1.6%) C. koseri proved to be overall ESBL-producers by double-disk synergy test. Third and fourth generation cephalosporin resistant P. mirabilis, P. stuartii and M. morganii strains mainly harboured a blaTEM gene (95.9%), while 89.1% of E. coli were positive for the blaCTX-M determinant by PCR and sequencing. Patients with decubitus had a higher risk of colonization by at least one resistant isolate (p < 0.01). Samples of patients undergoing antibiotic therapy and patients with decubitus showed a higher risk (p < 0.05) of colonization by beta-lactam resistant microorganisms. CONCLUSIONS: These data confirm the presence of high percentages of ESBL-positive Enterobacteria in Italian LTCFs and the predominance of CTX-M type ESBL in E. coli. The alarming presence of ESBL-producing Enterobacteriaceae in Italian LTCFs can seriously compromise the effectiveness of antibiotic therapy.acilities (LTCFs), Antimicrobial resistance. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/23497323/Prevalence_of_urinary_colonization_by_extended_spectrum_beta_lactamase_Enterobacteriaceae_among_catheterised_inpatients_in_Italian_long_term_care_facilities_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-13-124 DB - PRIME DP - Unbound Medicine ER -