Fecal carriage of extended-spectrum beta-lactamase-producing enterobacteriaceae in intensive care unit patients
Shalini Mulki, Kavya Ramamurthy, Sevitha Bhat
Keywords : Escherichia coli, extended-spectrum beta-lactamase, fecal carriage, Intensive Care Unit
Citation Information :
Mulki S, Ramamurthy K, Bhat S. Fecal carriage of extended-spectrum beta-lactamase-producing enterobacteriaceae in intensive care unit patients. Indian J Crit Care Med 2017; 21 (8):525-527.
Background and Aims: Increasing and indiscriminate use of antibiotics has led the bacteria to develop resistance to most of the antibiotics. Beta-lactamase production is the mechanism of resistance to beta-lactams. Extended-spectrum beta-lactamases (ESBLs) have been found in the members of Enterobacteriaceae such as Escherichia coli and Klebsiella spp. which are the common health-care-associated pathogens. The aim was to study the rate of fecal carriage of ESBL-producing Enterobacteriaceae in patients admitted to the Intensive Care Unit (ICU) of tertiary care hospital and follow them subsequently for the development of infections.
Materials and Methods: A hospital-based descriptive study was conducted in the department of microbiology of a tertiary care hospital for a period of 2 months from June 2016 to August 2016. Rectal swabs were collected from the patients admitted to the ICU after a period of 48 h. The swab was inoculated onto a special selective media (ChromID ESBL media). The results were noted according to the color of the colony produced. These patients are followed for the development of infection and the ESBL-producing organisms.
Results: A total of 60 rectal swabs were cultured, 39 (65%) showed a positive result. Out of which, 22 (56%) were ESBL-producing E. coli and 17 (43%) Klebsiella spp. Twenty-three (38%) of the total patients screened were infected with ESBL-producing organisms.
Conclusion: The study revealed high rates of carriage of ESBL producers in patients admitted to the ICU.
Isendahl J, Turlej-Rogacka A, Manjuba C, Rodrigues A, Giske CG, Nauclér P, et al. Fecal carriage of ESBL-producing E. coli and K. pneumoniae in children in Guinea-Bissau: A hospital-based cross-sectional study. PLoS One 2012;7:e51981.
Woerther PL, Burdet C, Chachaty E, Andremont A. Trends in human fecal carriage of extended-spectrum β-lactamases in the community: Toward the globalization of CTX-M. Clin Microbiol Rev 2013;26:744-58.
Valverde A, Coque TM, Sánchez-Moreno MP, Rollán A, Baquero F, Cantón R, et al. Dramatic increase in prevalence of fecal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae during nonoutbreak situations in Spain. J Clin Microbiol 2004;42:4769-75.
Mathai D, Kumar VA, Paul B, Sugumar M, John KR, Manoharan A, et al. Fecal carriage rates of extended-spectrum β-lactamase-producing Escherichia coli among antibiotic naive healthy human volunteers. Microb Drug Resist 2015;21:59-64.
Réglier-Poupet H, Naas T, Carrer A, Cady A, Adam JM, Fortineau N, et al. Performance of chromID ESBL, a chromogenic medium for detection of Enterobacteriaceae producing extended-spectrum beta-lactamases. J Med Microbiol 2008;57:310-5.
Kluytmans-van den Bergh MF, Verhulst C, Willemsen LE, Verkade E, Bonten MJ, Kluytmans JA, et al. Rectal carriage of extended-spectrum-beta-lactamase-producing Enterobacteriaceae in hospitalized patients: Selective preenrichment increases yield of screening. J Clin Microbiol 2015;53:2709-12.
Paniagua R, Valverde A, Coque TM, Baquero F, Cantón R. Assessment of prevalence and changing epidemiology of extended-spectrum beta-lactamase-producing Enterobacteriaceae fecal carriers using a chromogenic medium. Diagn Microbiol Infect Dis 2010;67:376-9.
Rodríguez-Baño J, López-Cerero L, Navarro MD, Díaz de Alba P, Pascual A. Faecal carriage of extended-spectrum beta-lactamase-producing Escherichia coli: Prevalence, risk factors and molecular epidemiology. J Antimicrob Chemother 2008;62:1142-9.
Reddy P, Malczynski M, Obias A, Reiner S, Jin N, Huang J, et al. Screening for extended-spectrum beta-lactamase-producing Enterobacteriaceae among high-risk patients and rates of subsequent bacteremia. Clin Infect Dis 2007;45:846-52.