Ann Lab Med.  2014 Jan;34(1):20-25. 10.3343/alm.2014.34.1.20.

Rates of Fecal Transmission of Extended-Spectrum beta-Lactamase-Producing and Carbapenem-Resistant Enterobacteriaceae Among Patients in Intensive Care Units in Korea

• Kim J
• Lee JY
• Kim SI
• Song W
• Kim JS
• Jung S
• Yu JK
• Park KG
• Park YJ

• KMID: 1781355
• DOI: http://doi.org/10.3343/alm.2014.34.1.20

Abstract

BACKGROUND
We investigated the rates of fecal transmission of extended-spectrum beta-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 (bioMerieux, 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.

Keyword

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

MeSH Terms

Anti-Bacterial Agents/pharmacology
Bacterial Proteins/*metabolism
Carbapenems/*pharmacology
Carrier State/epidemiology
Cross Infection/epidemiology/*transmission
DNA, Bacterial/analysis
Drug Resistance, Bacterial/drug effects
Electrophoresis, Gel, Pulsed-Field
Enterobacteriaceae/enzymology/genetics/*physiology
Enterobacteriaceae Infections/epidemiology/*transmission
Feces/*microbiology
Genotype
Humans
Intensive Care Units
Polymerase Chain Reaction
Prevalence
Republic of Korea/epidemiology
beta-Lactamases/*metabolism
Anti-Bacterial Agents
Bacterial Proteins
Carbapenems
DNA, Bacterial
beta-Lactamases

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