National Epidemiologic Surveys of Enterobacter aerogenes in Belgian Hospitals from 1996 to 1998

Abstract

Two national surveys were conducted to describe the incidence and prevalence of Enterobacter aerogenes in 21 Belgian hospitals in 1996 and 1997 and to characterize the genotypic diversity and the antimicrobial resistance profiles of clinical strains of E. aerogenes isolated from hospitalized patients in Belgium in 1997 and 1998. Twenty-nine hospitals collected 10 isolates of E. aerogenes, which were typed by arbitrarily primed PCR (AP-PCR) using two primers and pulsed-field gel electrophoresis. MICs of 10 antimicrobial agents were determined by the agar dilution method. Beta-lactamases were detected by the double-disk diffusion test and characterized by isoelectric point. The median incidence of E. aerogenes colonization or infection increased from 3.3 per 1,000 admissions in 1996 to 4.2 per 1000 admissions in the first half of 1997 (P < 0.01). E. aerogenes strains (n ‫؍‬ 260) clustered in 25 AP-PCR types. Two major types, BE1 and BE2, included 36 and 38% of strains and were found in 21 and 25 hospitals, respectively. The BE1 type was indistinguishable from a previously described epidemic strain in France. Half of the strains produced an extended-spectrum betalactamase, either TEM-24 (in 86% of the strains) or TEM-3 (in 14% of the strains). Over 75% of the isolates were resistant to ceftazidime, piperacillin-tazobactam, and ciprofloxacin. Over 90% of the strains were susceptible to cefepime, carbapenems, and aminoglycosides. In conclusion, these data suggest a nationwide dissemination of two epidemic multiresistant E. aerogenes strains in Belgian hospitals. TEM-24 beta-lactamase was frequently harbored by one of these epidemic strains, which appeared to be genotypically related to a TEM-24-producing epidemic strain from France, suggesting international dissemination.

Los laboratorios de microbiología del mundo pueden convertirse en una red de detección microbiana

“…The world's microbiology laboratories will have more information to track such spread when their data are all analyzed together, since microbial threats are increasingly seen as global epidemics (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). The strain of microbe infecting a patient anywhere now and the resistance gene blocking its treatment were rarely there a few years or decades earlier (20)(21)(22)(23)(24)(25)(26).…”

Caracterização molecular dos mecanismos de resistência aos carbapenêmicos de isolados clínicos de Enterobacter aerogenes e Enterobacter cloacae

“…As espécies de Enterobacter estão entre os Gram-negativos mais comuns em IRAS, sendo consideradas patógenos hospitalares emergentes, que comprometem principalmente pacientes internados em Unidades de Terapia Intensiva (UTI) e imunodeprimidos (6)(7)(8)(9). Estudos demonstram que estão associados com até 8 % de casos de bacteremias hospitalares e são o segundo patógeno Gram-negativo mais comum em pneumonias em pacientes de UTI em algumas casuísticas (6)(7)(8)(9) .…”

“…Estudos demonstram que estão associados com até 8 % de casos de bacteremias hospitalares e são o segundo patógeno Gram-negativo mais comum em pneumonias em pacientes de UTI em algumas casuísticas (6)(7)(8)(9) .…”

“…No entanto, E. aerogenes é o que vem se destacando como um importante patógeno nosocomial desde 1990, devido sua eficiente resposta adaptativa ao stress ambiental (25,26) . É uma das principais causas de IRAS em todo o mundo e um dos patógenos mais frequente descrito em infecções nosocomiais do trato respiratório e trato urinário de hospitais da Europa (7,27) .…”

“…Também é responsável por 8% dos casos de bacteremias nosocomias, com mortalidade de 29%, apresentando alta resistência a antibióticos de largo espectro (6,27,28) . (7,29,30) . Enterobacter podem expressar um aumento da sua produção e consequentemente resistência aos beta-lactâmicos (15,31) .…”