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High proportion of intestinal colonization with successful epidemic clones of ESBL-producing Enterobacteriaceae in a neonatal intensive care unit in Ecuador.
PLoS One. 2013; 8(10):e76597.Plos

Abstract

BACKGROUND AND AIMS

Neonatal infections caused by Extended-spectrum beta-lactamase (ESBL)-producing bacteria are associated with increased morbidity and mortality. No data are available on neonatal colonization with ESBL-producing bacteria in Ecuador. The aim of this study was to determine the proportion of intestinal colonization with ESBL-producing Enterobacteriaceae, their resistance pattern and risk factors of colonization in a neonatal intensive care unit in Ecuador.

METHODS

During a three month period, stool specimens were collected every two weeks from hospitalized neonates. Species identification and susceptibility testing were performed with Vitek2, epidemiologic typing with automated repetitive PCR. Associations between groups were analyzed using the Pearson X (2) test and Fisher exact test. A forward step logistic regression model identified significant predictors for colonization.

RESULTS

Fifty-six percent of the neonates were colonized with ESBL-producing Enterobacteriaceae. Length of stay longer than 20 days and enteral feeding with a combination of breastfeeding and formula feeding were significantly associated with ESBL-colonization. The strains found were E. coli (EC, 89%) and K. pneumoniae (KP, 11%) and epidemiological typing divided these isolates in two major clusters. All EC and KP had bla CTX-M group 1 except for a unique EC isolate that had bla CTX-M group 9. Multi-locus sequence typing performed on the K. pneumoniae strains showed that the strains belonged to ST855 and ST897. The two detected STs belong to two different epidemic clonal complexes (CC), CC11 and CC14, which previously have been associated with dissemination of carbapenemases. None of the E. coli strains belonged to the epidemic ST 131 clone.

CONCLUSIONS

More than half of the neonates were colonized with ESBL-producing Enterobacteriaceae where the main risk factor for colonization was length of hospital stay. Two of the isolated clones were epidemic and known to disseminate carbapenemases. The results underline the necessity for improved surveillance and infection control in this context.

Authors+Show Affiliations

Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden ; Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24146896

Citation

Nordberg, Viveka, et al. "High Proportion of Intestinal Colonization With Successful Epidemic Clones of ESBL-producing Enterobacteriaceae in a Neonatal Intensive Care Unit in Ecuador." PloS One, vol. 8, no. 10, 2013, pp. e76597.
Nordberg V, Quizhpe Peralta A, Galindo T, et al. High proportion of intestinal colonization with successful epidemic clones of ESBL-producing Enterobacteriaceae in a neonatal intensive care unit in Ecuador. PLoS ONE. 2013;8(10):e76597.
Nordberg, V., Quizhpe Peralta, A., Galindo, T., Turlej-Rogacka, A., Iversen, A., Giske, C. G., & Navér, L. (2013). High proportion of intestinal colonization with successful epidemic clones of ESBL-producing Enterobacteriaceae in a neonatal intensive care unit in Ecuador. PloS One, 8(10), e76597. https://doi.org/10.1371/journal.pone.0076597
Nordberg V, et al. High Proportion of Intestinal Colonization With Successful Epidemic Clones of ESBL-producing Enterobacteriaceae in a Neonatal Intensive Care Unit in Ecuador. PLoS ONE. 2013;8(10):e76597. PubMed PMID: 24146896.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High proportion of intestinal colonization with successful epidemic clones of ESBL-producing Enterobacteriaceae in a neonatal intensive care unit in Ecuador. AU - Nordberg,Viveka, AU - Quizhpe Peralta,Arturo, AU - Galindo,Telmo, AU - Turlej-Rogacka,Agata, AU - Iversen,Aina, AU - Giske,Christian G, AU - Navér,Lars, Y1 - 2013/10/11/ PY - 2013/05/16/received PY - 2013/09/03/accepted PY - 2013/10/23/entrez PY - 2013/10/23/pubmed PY - 2014/8/15/medline SP - e76597 EP - e76597 JF - PloS one JO - PLoS ONE VL - 8 IS - 10 N2 - BACKGROUND AND AIMS: Neonatal infections caused by Extended-spectrum beta-lactamase (ESBL)-producing bacteria are associated with increased morbidity and mortality. No data are available on neonatal colonization with ESBL-producing bacteria in Ecuador. The aim of this study was to determine the proportion of intestinal colonization with ESBL-producing Enterobacteriaceae, their resistance pattern and risk factors of colonization in a neonatal intensive care unit in Ecuador. METHODS: During a three month period, stool specimens were collected every two weeks from hospitalized neonates. Species identification and susceptibility testing were performed with Vitek2, epidemiologic typing with automated repetitive PCR. Associations between groups were analyzed using the Pearson X (2) test and Fisher exact test. A forward step logistic regression model identified significant predictors for colonization. RESULTS: Fifty-six percent of the neonates were colonized with ESBL-producing Enterobacteriaceae. Length of stay longer than 20 days and enteral feeding with a combination of breastfeeding and formula feeding were significantly associated with ESBL-colonization. The strains found were E. coli (EC, 89%) and K. pneumoniae (KP, 11%) and epidemiological typing divided these isolates in two major clusters. All EC and KP had bla CTX-M group 1 except for a unique EC isolate that had bla CTX-M group 9. Multi-locus sequence typing performed on the K. pneumoniae strains showed that the strains belonged to ST855 and ST897. The two detected STs belong to two different epidemic clonal complexes (CC), CC11 and CC14, which previously have been associated with dissemination of carbapenemases. None of the E. coli strains belonged to the epidemic ST 131 clone. CONCLUSIONS: More than half of the neonates were colonized with ESBL-producing Enterobacteriaceae where the main risk factor for colonization was length of hospital stay. Two of the isolated clones were epidemic and known to disseminate carbapenemases. The results underline the necessity for improved surveillance and infection control in this context. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/24146896/High_proportion_of_intestinal_colonization_with_successful_epidemic_clones_of_ESBL_producing_Enterobacteriaceae_in_a_neonatal_intensive_care_unit_in_Ecuador_ L2 - http://dx.plos.org/10.1371/journal.pone.0076597 DB - PRIME DP - Unbound Medicine ER -