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Rates of fecal transmission of extended-spectrum β-lactamase-producing and carbapenem-resistant Enterobacteriaceae among patients in intensive care units in Korea.
Ann Lab Med. 2014 Jan; 34(1):20-5.AL

Abstract

BACKGROUND

We investigated the rates of fecal transmission of extended-spectrum β-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 (bioMérieux, 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.

Authors+Show Affiliations

Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea.Department of Infection Control, Seoul St. Mary's Hospital, Seoul, Korea.Division of Infectious Disease, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea.Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea.Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea.Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.

Pub Type(s)

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

Language

eng

PubMed ID

24422191

Citation

Kim, Jayoung, et al. "Rates of Fecal Transmission of Extended-spectrum Β-lactamase-producing and Carbapenem-resistant Enterobacteriaceae Among Patients in Intensive Care Units in Korea." Annals of Laboratory Medicine, vol. 34, no. 1, 2014, pp. 20-5.
Kim J, Lee JY, Kim SI, et al. Rates of fecal transmission of extended-spectrum β-lactamase-producing and carbapenem-resistant Enterobacteriaceae among patients in intensive care units in Korea. Ann Lab Med. 2014;34(1):20-5.
Kim, J., Lee, J. Y., Kim, S. I., Song, W., Kim, J. S., Jung, S., Yu, J. K., Park, K. G., & Park, Y. J. (2014). Rates of fecal transmission of extended-spectrum β-lactamase-producing and carbapenem-resistant Enterobacteriaceae among patients in intensive care units in Korea. Annals of Laboratory Medicine, 34(1), 20-5. https://doi.org/10.3343/alm.2014.34.1.20
Kim J, et al. Rates of Fecal Transmission of Extended-spectrum Β-lactamase-producing and Carbapenem-resistant Enterobacteriaceae Among Patients in Intensive Care Units in Korea. Ann Lab Med. 2014;34(1):20-5. PubMed PMID: 24422191.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rates of fecal transmission of extended-spectrum β-lactamase-producing and carbapenem-resistant Enterobacteriaceae among patients in intensive care units in Korea. AU - Kim,Jayoung, AU - Lee,Ji Young, AU - Kim,Sang Il, AU - Song,Wonkeun, AU - Kim,Jae-Seok, AU - Jung,Seungwon, AU - Yu,Jin Kyung, AU - Park,Kang Gyun, AU - Park,Yeon-Joon, Y1 - 2013/12/06/ PY - 2013/05/06/received PY - 2013/08/12/revised PY - 2013/10/17/accepted PY - 2014/1/15/entrez PY - 2014/1/15/pubmed PY - 2014/7/2/medline KW - CRE KW - CTX-M KW - Colonization KW - ESBL-E KW - Rectal swab KW - Transmission SP - 20 EP - 5 JF - Annals of laboratory medicine JO - Ann Lab Med VL - 34 IS - 1 N2 - BACKGROUND: We investigated the rates of fecal transmission of extended-spectrum β-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 (bioMérieux, 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. SN - 2234-3814 UR - https://www.unboundmedicine.com/medline/citation/24422191/Rates_of_fecal_transmission_of_extended_spectrum_β_lactamase_producing_and_carbapenem_resistant_Enterobacteriaceae_among_patients_in_intensive_care_units_in_Korea_ L2 - http://www.annlabmed.org/journal/viewJournal.html?year=2014&vol=34&page=20 DB - PRIME DP - Unbound Medicine ER -