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Neonatal intestinal colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae-a 5-year follow-up study.
Clin Microbiol Infect. 2018 Sep; 24(9):1004-1009.CM

Abstract

OBJECTIVES

To analyse Klebsiella pneumoniae (KP) isolates from an outbreak of extended-spectrum β-lactamase (ESBL)-producing KP and Escherichia coli (EC) among infants admitted to neonatal intensive care units and to determine the duration of the intestinal colonization.

METHODS

We performed a prospective cohort study of intestinal ESBL-KP/ESBL-EC colonized neonates after a 5-month outbreak in two neonatal intensive care units. Whole genome sequencing, multilocus sequence typing, core genome multilocus sequence typing, pulsed-field electrophoresis and PCR for blaCTX-M were performed on the first isolates. Stool cultures were performed every second month after discharge until 2 years after discharge and at 5 years of age. The last positive samples were analysed with pulsed-field gel electrophoresis and PCR for blaCTX-M. The intestinal relative dominance of ESBL-producing Enterobacteriaceae was determined.

RESULTS

Thirteen of 17 patients colonized with ESBL-KP/ESBL-EC survived. Isolates from 16 of 17 patients were available for analysis and featured the same strain type of ESBL-KP: sequence type 101. The strain had capsule type K29 and harboured blaCTX-M-15. The virulence genes irp1, irp2, iutA, kfu and mrk were detected in all isolates. The median length of colonization was 12.5 months (range, 5-68 months). After 2 years, two of 13 patients were carriers of ESBL-KP and one of 13 of ESBL-EC. At 5 years of age, one neonate was colonized with ESBL-EC. No infant experienced an ESBL-KP/EC-infection during follow-up.

CONCLUSIONS

Two years after discharge, almost one fourth of the study participants were ESBL/KP-EC carriers. ESBL-KP sequence type 101 persisted in two of 13 children for 23 to 26 months. One patient was colonized with ESBL-EC at age 5 years.

Authors+Show Affiliations

Department of Neonatal Medicine, Karolinska University Hospital, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Paediatrics, Karolinska Institutet, Sweden. Electronic address: viveka.nordberg@ki.se.Department of Neonatal Medicine, Karolinska University Hospital, Sweden.Department of Clinical Microbiology, Karolinska University Hospital, Sweden; Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Sweden.Department of Clinical Microbiology, Karolinska University Hospital, Sweden; Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Sweden.The Public Health Agency of Sweden, Stockholm, Sweden.Department of Neonatal Medicine, Karolinska University Hospital, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Sweden.Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Sweden.Department of Neonatal Medicine, Karolinska University Hospital, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Paediatrics, Karolinska Institutet, Sweden.Department of Neonatal Medicine, Karolinska University Hospital, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Paediatrics, Karolinska Institutet, Sweden.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29326011

Citation

Nordberg, V, et al. "Neonatal Intestinal Colonization With Extended-spectrum Β-lactamase-producing Enterobacteriaceae-a 5-year Follow-up Study." Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, vol. 24, no. 9, 2018, pp. 1004-1009.
Nordberg V, Jonsson K, Giske CG, et al. Neonatal intestinal colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae-a 5-year follow-up study. Clin Microbiol Infect. 2018;24(9):1004-1009.
Nordberg, V., Jonsson, K., Giske, C. G., Iversen, A., Aspevall, O., Jonsson, B., Camporeale, A., Norman, M., & Navér, L. (2018). Neonatal intestinal colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae-a 5-year follow-up study. Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, 24(9), 1004-1009. https://doi.org/10.1016/j.cmi.2017.12.028
Nordberg V, et al. Neonatal Intestinal Colonization With Extended-spectrum Β-lactamase-producing Enterobacteriaceae-a 5-year Follow-up Study. Clin Microbiol Infect. 2018;24(9):1004-1009. PubMed PMID: 29326011.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neonatal intestinal colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae-a 5-year follow-up study. AU - Nordberg,V, AU - Jonsson,K, AU - Giske,C G, AU - Iversen,A, AU - Aspevall,O, AU - Jonsson,B, AU - Camporeale,A, AU - Norman,M, AU - Navér,L, Y1 - 2018/01/08/ PY - 2017/07/12/received PY - 2017/12/14/revised PY - 2017/12/28/accepted PY - 2018/1/13/pubmed PY - 2018/11/14/medline PY - 2018/1/13/entrez KW - ESBL KW - Intestinal colonization KW - Klebsiella pneumoniae KW - Neonatal KW - Sequence type SP - 1004 EP - 1009 JF - Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases JO - Clin. Microbiol. Infect. VL - 24 IS - 9 N2 - OBJECTIVES: To analyse Klebsiella pneumoniae (KP) isolates from an outbreak of extended-spectrum β-lactamase (ESBL)-producing KP and Escherichia coli (EC) among infants admitted to neonatal intensive care units and to determine the duration of the intestinal colonization. METHODS: We performed a prospective cohort study of intestinal ESBL-KP/ESBL-EC colonized neonates after a 5-month outbreak in two neonatal intensive care units. Whole genome sequencing, multilocus sequence typing, core genome multilocus sequence typing, pulsed-field electrophoresis and PCR for blaCTX-M were performed on the first isolates. Stool cultures were performed every second month after discharge until 2 years after discharge and at 5 years of age. The last positive samples were analysed with pulsed-field gel electrophoresis and PCR for blaCTX-M. The intestinal relative dominance of ESBL-producing Enterobacteriaceae was determined. RESULTS: Thirteen of 17 patients colonized with ESBL-KP/ESBL-EC survived. Isolates from 16 of 17 patients were available for analysis and featured the same strain type of ESBL-KP: sequence type 101. The strain had capsule type K29 and harboured blaCTX-M-15. The virulence genes irp1, irp2, iutA, kfu and mrk were detected in all isolates. The median length of colonization was 12.5 months (range, 5-68 months). After 2 years, two of 13 patients were carriers of ESBL-KP and one of 13 of ESBL-EC. At 5 years of age, one neonate was colonized with ESBL-EC. No infant experienced an ESBL-KP/EC-infection during follow-up. CONCLUSIONS: Two years after discharge, almost one fourth of the study participants were ESBL/KP-EC carriers. ESBL-KP sequence type 101 persisted in two of 13 children for 23 to 26 months. One patient was colonized with ESBL-EC at age 5 years. SN - 1469-0691 UR - https://www.unboundmedicine.com/medline/citation/29326011/Neonatal_intestinal_colonization_with_extended_spectrum_β_lactamase_producing_Enterobacteriaceae_a_5_year_follow_up_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1198-743X(18)30045-4 DB - PRIME DP - Unbound Medicine ER -