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Ann Lab Med. 2014 Jan;34(1):20-5. doi: 10.3343/alm.2014.34.1.20. Epub 2013 Dec 6.

Rates of fecal transmission of extended-spectrum β-lactamase-producing and carbapenem-resistant Enterobacteriaceae among patients in intensive care units in Korea.

Author information

1
Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea.
2
Department of Infection Control, Seoul St. Mary's Hospital, Seoul, Korea.
3
Division of Infectious Disease, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
4
Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea.
5
Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.

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.

KEYWORDS:

CRE; CTX-M; Colonization; ESBL-E; Rectal swab; Transmission

PMID:
24422191
PMCID:
PMC3885768
DOI:
10.3343/alm.2014.34.1.20
[Indexed for MEDLINE]
Free PMC Article

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