Extended spectrum beta-lactamase producing Enterobacterales faecal carriage in a medical intensive care unit: low rates of cross-transmission and infection
Abstract Background Extended-spectrum beta-lactamases-producing Enterobacterales (ESBL-E) are disseminating worldwide especially in Intensive Care Units (ICUs) and are responsible for increased health costs and mortality. The aims of this work were to study ESBL-E dissemination in ICU and to assess...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-07-01
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| Series: | Antimicrobial Resistance and Infection Control |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13756-019-0572-9 |
| _version_ | 1818171641971081216 |
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| author | Renaud Prevel Alexandre Boyer Fatima M’Zali Thibaut Cockenpot Agnes Lasheras Véronique Dubois Didier Gruson |
| author_facet | Renaud Prevel Alexandre Boyer Fatima M’Zali Thibaut Cockenpot Agnes Lasheras Véronique Dubois Didier Gruson |
| author_sort | Renaud Prevel |
| collection | DOAJ |
| description | Abstract Background Extended-spectrum beta-lactamases-producing Enterobacterales (ESBL-E) are disseminating worldwide especially in Intensive Care Units (ICUs) and are responsible for increased health costs and mortality. The aims of this work were to study ESBL-E dissemination in ICU and to assess the impact of ESBL-E fecal carriage on subsequent infections during a non-outbreak situation. Methods We therefore screened every patient at admission then once a week in a medical ICU between January and June 2015. Each ESBL-E isolate was characterized by ESBL genes PCR amplification and the clonal dissemination was assessed by Pulsed-Field Gel Electrophoresis (PFGE). Results Among the 608 screened patients, 55 (9%) were colonized by ESBL-E. Forty-four isolates were available for further analysis. Most of them (43/44, 98%) contained a ESBL gene from the CTX-M group. Only one case of ESBL-E cross-transmission occurred, even for acquired ESBL-E colonization. Subsequent infection by ESBL-E occurred in 6/55 (11%) patients and infecting ESBL-E strains were the colonizing ones. ESBL-E faecal carriage had a negative predictive value of 100% and a positive predictive value of 40% to predict ESBL-E ventilator associated-pneumonia (VAP). Alternatives to carbapenems consisting in piperacillin-tazobactam, ceftolozane-tazobactam and ceftazidime-avibactam were all active on this panel of ESBL-E. Conclusions ESBL-E expansion and acquisition in ICU in a non-outbreak situation are not any more fully explained by cross-transmission. Mechanisms underlying ESBL-E dissemination in ICU are still to investigate. Interestingly, as far as we know, our study demonstrates for the first time by PFGE that the colonizing strain is indeed the infecting one in case of subsequent ESBL-E infection. Nevertheless, subsequent ESBL-E infection remains a rare event conferring poor positive predictive value for ESBL-E colonization to predict ESBL-E VAP. Relevance of systematic ESBL-E faecal screening at ICU admission and during ICU stay needs further investigation. |
| first_indexed | 2024-12-11T18:59:57Z |
| format | Article |
| id | doaj.art-6f3b92f99b0f474bb16e7ebc6e8a8422 |
| institution | Directory Open Access Journal |
| issn | 2047-2994 |
| language | English |
| last_indexed | 2024-12-11T18:59:57Z |
| publishDate | 2019-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Antimicrobial Resistance and Infection Control |
| spelling | doaj.art-6f3b92f99b0f474bb16e7ebc6e8a84222022-12-22T00:54:02ZengBMCAntimicrobial Resistance and Infection Control2047-29942019-07-01811710.1186/s13756-019-0572-9Extended spectrum beta-lactamase producing Enterobacterales faecal carriage in a medical intensive care unit: low rates of cross-transmission and infectionRenaud Prevel0Alexandre Boyer1Fatima M’Zali2Thibaut Cockenpot3Agnes Lasheras4Véronique Dubois5Didier Gruson6Medical Intensive Care Unit, CHU Bordeaux, Pellegrin universitary hospitalMedical Intensive Care Unit, CHU Bordeaux, Pellegrin universitary hospitalUMR 5234 CNRS, Bordeaux UniversityBacteriology laboratory, CHU BordeauxHygiene unit, CHU BordeauxUMR 5234 CNRS, Bordeaux UniversityMedical Intensive Care Unit, CHU Bordeaux, Pellegrin universitary hospitalAbstract Background Extended-spectrum beta-lactamases-producing Enterobacterales (ESBL-E) are disseminating worldwide especially in Intensive Care Units (ICUs) and are responsible for increased health costs and mortality. The aims of this work were to study ESBL-E dissemination in ICU and to assess the impact of ESBL-E fecal carriage on subsequent infections during a non-outbreak situation. Methods We therefore screened every patient at admission then once a week in a medical ICU between January and June 2015. Each ESBL-E isolate was characterized by ESBL genes PCR amplification and the clonal dissemination was assessed by Pulsed-Field Gel Electrophoresis (PFGE). Results Among the 608 screened patients, 55 (9%) were colonized by ESBL-E. Forty-four isolates were available for further analysis. Most of them (43/44, 98%) contained a ESBL gene from the CTX-M group. Only one case of ESBL-E cross-transmission occurred, even for acquired ESBL-E colonization. Subsequent infection by ESBL-E occurred in 6/55 (11%) patients and infecting ESBL-E strains were the colonizing ones. ESBL-E faecal carriage had a negative predictive value of 100% and a positive predictive value of 40% to predict ESBL-E ventilator associated-pneumonia (VAP). Alternatives to carbapenems consisting in piperacillin-tazobactam, ceftolozane-tazobactam and ceftazidime-avibactam were all active on this panel of ESBL-E. Conclusions ESBL-E expansion and acquisition in ICU in a non-outbreak situation are not any more fully explained by cross-transmission. Mechanisms underlying ESBL-E dissemination in ICU are still to investigate. Interestingly, as far as we know, our study demonstrates for the first time by PFGE that the colonizing strain is indeed the infecting one in case of subsequent ESBL-E infection. Nevertheless, subsequent ESBL-E infection remains a rare event conferring poor positive predictive value for ESBL-E colonization to predict ESBL-E VAP. Relevance of systematic ESBL-E faecal screening at ICU admission and during ICU stay needs further investigation.http://link.springer.com/article/10.1186/s13756-019-0572-9Extended-spectrum beta-lactamaseCarriageCross-transmissionInfectionVentilator-associated pneumoniaIntensive care |
| spellingShingle | Renaud Prevel Alexandre Boyer Fatima M’Zali Thibaut Cockenpot Agnes Lasheras Véronique Dubois Didier Gruson Extended spectrum beta-lactamase producing Enterobacterales faecal carriage in a medical intensive care unit: low rates of cross-transmission and infection Antimicrobial Resistance and Infection Control Extended-spectrum beta-lactamase Carriage Cross-transmission Infection Ventilator-associated pneumonia Intensive care |
| title | Extended spectrum beta-lactamase producing Enterobacterales faecal carriage in a medical intensive care unit: low rates of cross-transmission and infection |
| title_full | Extended spectrum beta-lactamase producing Enterobacterales faecal carriage in a medical intensive care unit: low rates of cross-transmission and infection |
| title_fullStr | Extended spectrum beta-lactamase producing Enterobacterales faecal carriage in a medical intensive care unit: low rates of cross-transmission and infection |
| title_full_unstemmed | Extended spectrum beta-lactamase producing Enterobacterales faecal carriage in a medical intensive care unit: low rates of cross-transmission and infection |
| title_short | Extended spectrum beta-lactamase producing Enterobacterales faecal carriage in a medical intensive care unit: low rates of cross-transmission and infection |
| title_sort | extended spectrum beta lactamase producing enterobacterales faecal carriage in a medical intensive care unit low rates of cross transmission and infection |
| topic | Extended-spectrum beta-lactamase Carriage Cross-transmission Infection Ventilator-associated pneumonia Intensive care |
| url | http://link.springer.com/article/10.1186/s13756-019-0572-9 |
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