High Proportion of Intestinal Colonization with Successful Epidemic Clones of ESBL-Producing Enterobacteriaceae in a Neonatal Intensive Care Unit in Ecuador

Abstract

Background and AimsNeonatal infections caused by Extended-spectrum beta-lactamase (ESBL)-producing bacteria are associated with increased morbidity and mortality. No data are available on neonatal colonization with ESBL-producing bacteria in Ecuador. The aim of this study was to determine the proportion of intestinal colonization with ESBL-producing Enterobacteriaceae, their resistance pattern and risk factors of colonization in a neonatal intensive care unit in Ecuador.MethodsDuring a three month period, stool specimens were collected every two weeks from hospitalized neonates. Species identification and susceptibility testing were performed with Vitek2, epidemiologic typing with automated repetitive PCR. Associations between groups were analyzed using the Pearson X 2 test and Fisher exact test. A forward step logistic regression model identified significant predictors for colonization.ResultsFifty-six percent of the neonates were colonized with ESBL-producing Enterobacteriaceae. Length of stay longer than 20 days and enteral feeding with a combination of breastfeeding and formula feeding were significantly associated with ESBL-colonization. The strains found were E. coli (EC, 89%) and K. pneumoniae (KP, 11%) and epidemiological typing divided these isolates in two major clusters. All EC and KP had bla CTX-M group 1 except for a unique EC isolate that had bla CTX-M group 9. Multi-locus sequence typing performed on the K. pneumoniae strains showed that the strains belonged to ST855 and ST897. The two detected STs belong to two different epidemic clonal complexes (CC), CC11 and CC14, which previously have been associated with dissemination of carbapenemases. None of the E. coli strains belonged to the epidemic ST 131 clone.ConclusionsMore than half of the neonates were colonized with ESBL-producing Enterobacteriaceae where the main risk factor for colonization was length of hospital stay. Two of the isolated clones were epidemic and known to disseminate carbapenemases. The results underline the necessity for improved surveillance and infection control in this context.

Extended-Spectrum -Lactamase-Producing Enterobacteriaceae in Children: Old Foe, Emerging Threat

“…A single cause for the increase was not identified, although 33% of children reported receiving antibiotics within 2 weeks of the study [66]. In contrast, a prospective surveillance study of E. coli and K. pneumoniae rectal carriage in an Ecuadorian NICU over a 3-month period in 2011 suggests that there remains significant geographic variation in circulating strains, as CTX-M group 1 with 2 distinct genetic clusters was responsible for dissemination in this region [68].…”

“…Meanwhile, SMART data from 2008 to 2010 showed ESBLs accounting for 23% of pediatric E. coli intra-abdominal infections [20]. Historically, CTX-M-2 ESBLs have a known niche in South American countries, and data of healthcare-associated and community-acquired ESBL infections in children confirm high prevalence of this enzyme across Enterobacteriaceae, although CTX-M-15 has been increasingly described [55,[66][67][68].…”

Colonisation with extended spectrum beta-lactamase-producing and carbapenem-resistant Enterobacterales in children admitted to a paediatric referral hospital in South Africa

“…Factors which predispose to ESBL-PE colonisation in the neonatal period include prior carbapenem, penicillin and aminoglycoside exposure, prolonged hospitalisation, early onset pneumonia, prolonged antibiotic use, formula milk feeds, and having an ESBL-PE colonised mother [8,9,10,[20][21][22][23][24]. Risk factors for ESBL-PE colonisation in older children include mechanical ventilation, prolonged hospital stay, prior antibiotic use and prior hospitalisation [11,12].…”

Acquisition of extended spectrum beta-lactamase-producing enterobacteriaceae in neonates: A community based cohort in Madagascar

“…After birth, the intestinal tract of newborns is colonized by the maternal and environment flora [ 18 ] which represents the first step for potential neonatal infections [ 19 ]. However, data regarding the acquisition of ESBL-PE during the neonatal period are scarce [ 20 ]. Bacteria that first colonize the neonatal gut are from different sources (maternal, health-care facilities, community) and the routes of transmission are not well defined [ 21 ].The maternal carriage of ESBL-PE is likely to play a significant role in the colonization and/or infection of newborns in the first week of life [ 22 ].…”