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Carriage of beta-lactamase-producing Enterobacteriaceae among nursing home residents in north Lebanon.
Int J Infect Dis. 2016 Apr; 45:24-31.IJ

Abstract

BACKGROUND

Multidrug-resistant (MDR) Enterobacteriaceae can cause severe infections with high morbidity, mortality, and health care costs. Individuals can be fecal carriers of these resistant organisms. Data on the extent of MDR Enterobacteriaceae fecal carriage in the community setting in Lebanon are very scarce. The aim of this study was to investigate the fecal carriage of MDR Enterobacteriaceae among the elderly residents of two nursing homes located in north Lebanon.

METHODS

Over a period of 4 months, five fecal swab samples were collected from each of 68 elderly persons at regular intervals of 3-4 weeks. Fecal swabs were subcultured on selective media for the screening of resistant organisms. The phenotypic detection of extended-spectrum beta-lactamase (ESBL), AmpC, metallo-beta-lactamase (MBL), and Klebsiella pneumoniae carbapenemase (KPC) production was performed using the beta-lactamase inhibitors ethylenediaminetetraacetic acid, phenylboronic acid, and cloxacillin. A temocillin disk was used for OXA-48. Multiplex PCRs were used for the genotypic detection of ESBL and carbapenemase genes, and sequencing was performed to identify CTX-M-15. The medical records of each subject were reviewed on a regular basis in order to assess the risk factors associated with MDR Enterobacteriaceae fecal carriage.

RESULTS

Over the study period, 76.5% of the recruited elderly persons were at least one-time carriers. A total of 178 isolates were obtained. Phenotypic testing revealed that 91.5% of them were ESBL producers, 4% were AmpC producers, 2.8% were co-producers of ESBL and AmpC, and 1.7% were co-producers of OXA-48 and ESBL. Recent antibiotic intake was found to be the only independent risk factor associated with the fecal carriage of MDR Enterobacteriaceae.

CONCLUSIONS

The high prevalence of MDR Enterobacteriaceae detected in this study and the emergence of carbapenem resistance is alarming. Efficient infection control measures and antibiotic stewardship programs are urgently needed in these settings in order to limit the spread of resistant strains.

Authors+Show Affiliations

Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, PO Box 33, Amioun, Beirut, Lebanon.Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, PO Box 33, Amioun, Beirut, Lebanon.Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, PO Box 33, Amioun, Beirut, Lebanon.Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, PO Box 33, Amioun, Beirut, Lebanon.Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, PO Box 33, Amioun, Beirut, Lebanon. Electronic address: ziad.daoud@balamand.edu.lb.

Pub Type(s)

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

Language

eng

PubMed ID

26899954

Citation

Dandachi, Iman, et al. "Carriage of Beta-lactamase-producing Enterobacteriaceae Among Nursing Home Residents in North Lebanon." International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, vol. 45, 2016, pp. 24-31.
Dandachi I, Salem Sokhn E, Najem E, et al. Carriage of beta-lactamase-producing Enterobacteriaceae among nursing home residents in north Lebanon. Int J Infect Dis. 2016;45:24-31.
Dandachi, I., Salem Sokhn, E., Najem, E., Azar, E., & Daoud, Z. (2016). Carriage of beta-lactamase-producing Enterobacteriaceae among nursing home residents in north Lebanon. International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, 45, 24-31. https://doi.org/10.1016/j.ijid.2016.02.007
Dandachi I, et al. Carriage of Beta-lactamase-producing Enterobacteriaceae Among Nursing Home Residents in North Lebanon. Int J Infect Dis. 2016;45:24-31. PubMed PMID: 26899954.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Carriage of beta-lactamase-producing Enterobacteriaceae among nursing home residents in north Lebanon. AU - Dandachi,Iman, AU - Salem Sokhn,Elie, AU - Najem,Elie, AU - Azar,Eid, AU - Daoud,Ziad, Y1 - 2016/02/17/ PY - 2015/12/15/received PY - 2016/01/18/revised PY - 2016/02/10/accepted PY - 2016/2/23/entrez PY - 2016/2/24/pubmed PY - 2016/12/15/medline KW - Carbapenemases KW - Carriage KW - ESBLs KW - Nursing homes KW - Resistance SP - 24 EP - 31 JF - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases JO - Int. J. Infect. Dis. VL - 45 N2 - BACKGROUND: Multidrug-resistant (MDR) Enterobacteriaceae can cause severe infections with high morbidity, mortality, and health care costs. Individuals can be fecal carriers of these resistant organisms. Data on the extent of MDR Enterobacteriaceae fecal carriage in the community setting in Lebanon are very scarce. The aim of this study was to investigate the fecal carriage of MDR Enterobacteriaceae among the elderly residents of two nursing homes located in north Lebanon. METHODS: Over a period of 4 months, five fecal swab samples were collected from each of 68 elderly persons at regular intervals of 3-4 weeks. Fecal swabs were subcultured on selective media for the screening of resistant organisms. The phenotypic detection of extended-spectrum beta-lactamase (ESBL), AmpC, metallo-beta-lactamase (MBL), and Klebsiella pneumoniae carbapenemase (KPC) production was performed using the beta-lactamase inhibitors ethylenediaminetetraacetic acid, phenylboronic acid, and cloxacillin. A temocillin disk was used for OXA-48. Multiplex PCRs were used for the genotypic detection of ESBL and carbapenemase genes, and sequencing was performed to identify CTX-M-15. The medical records of each subject were reviewed on a regular basis in order to assess the risk factors associated with MDR Enterobacteriaceae fecal carriage. RESULTS: Over the study period, 76.5% of the recruited elderly persons were at least one-time carriers. A total of 178 isolates were obtained. Phenotypic testing revealed that 91.5% of them were ESBL producers, 4% were AmpC producers, 2.8% were co-producers of ESBL and AmpC, and 1.7% were co-producers of OXA-48 and ESBL. Recent antibiotic intake was found to be the only independent risk factor associated with the fecal carriage of MDR Enterobacteriaceae. CONCLUSIONS: The high prevalence of MDR Enterobacteriaceae detected in this study and the emergence of carbapenem resistance is alarming. Efficient infection control measures and antibiotic stewardship programs are urgently needed in these settings in order to limit the spread of resistant strains. SN - 1878-3511 UR - https://www.unboundmedicine.com/medline/citation/26899954/Carriage_of_beta_lactamase_producing_Enterobacteriaceae_among_nursing_home_residents_in_north_Lebanon_ L2 - http://linkinghub.elsevier.com/retrieve/pii/S1201-9712(16)00027-8 DB - PRIME DP - Unbound Medicine ER -