Pretransplant Fecal Carriage of Extended-Spectrum β-Lactamase–producing<i>Enterobacteriaceae</i>and Infection after Liver Transplant, France

Bert, Frédéric; Larroque, Béatrice; Paugam–Burtz, Catherine; Dondero, Fédérica; Durand, François; Marcon, Estelle; Belghiti, Jacques; Moreau, Richard; Nicolas–Chanoine, Marie–Hélène

doi:10.3201/eid1806.110139

Cited by 95 publications

(111 citation statements)

References 34 publications

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“…Our findings are consistent with those from previous animal (9) and clinical (12) studies. Persistent intestinal colonization by endogenous flora carrying resistance genes would increase the likelihood of the transmission of resistance to the community (42) and of future infection by resistant pathogens (43,44). Clinicians caring for patients who have had recent ICU stays should consider previous colonization by resistant pathogens and their antibiotic resistance spectra.…”

Section: Discussionmentioning

confidence: 99%

Severe Sepsis Facilitates Intestinal Colonization by Extended-Spectrum-β-Lactamase-Producing Klebsiella pneumoniae and Transfer of the SHV-18 Resistance Gene to Escherichia coli during Antimicrobial Treatment

Guan

Liu

Zhou

et al. 2014

Antimicrob Agents Chemother

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bInfections caused by multidrug-resistant pathogens are frequent and life threatening in critically ill patients. To investigate whether severe sepsis affects gut colonization by resistant pathogens and genetic exchange between opportunistic pathogens, we tested the intestinal-colonization ability of an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae strain carrying the SHV-18 resistance gene and the transfer ability of the resistance gene to endogenous Escherichia coli under ceftriaxone treatment in rats with burn injury only or severe sepsis induced by burns plus endotoxin exposure. Without ceftriaxone treatment, the K. pneumoniae strain colonized the intestine in both septic and burned rats for a short time, with clearance occurring earlier in burn-only rats but never in sham burn rats. In both burned and septic rats, the colonization level of the challenge strain dropped at the beginning and then later increased during ceftriaxone treatment, after which it declined gradually. This pattern coincided with the change in resistance of K. pneumoniae to ceftriaxone during and after ceftriaxone treatment. Compared with burn-only injury, severe sepsis had a more significant effect on the change in antimicrobial resistance to ceftriaxone. Only in septic rats was the resistance gene successfully transferred from the challenge strain to endogenous E. coli during ceftriaxone treatment; the gene persisted for at least 4 weeks after ceftriaxone treatment. We concluded that severe sepsis can facilitate intestinal colonization by an exogenous resistant pathogen and the transfer of the resistance gene to a potential endogenous pathogen during antimicrobial treatment.

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Section: Discussionmentioning

confidence: 99%

Severe Sepsis Facilitates Intestinal Colonization by Extended-Spectrum-β-Lactamase-Producing Klebsiella pneumoniae and Transfer of the SHV-18 Resistance Gene to Escherichia coli during Antimicrobial Treatment

Guan

Liu

Zhou

et al. 2014

Antimicrob Agents Chemother

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“…Because we studied commensals, only 8 ESBL isolates were B2, and 3 among them were ST131. This may be seen as a study limitation; however, ESBL E. coli carriage has been shown in several studies to precede infection, and carriage of ESBL E. coli is linked to the risk of ESBL urinary tract infections in women with the same clone of ESBL E. coli found in urine samples as in fecal samples (3,18,19).…”

mentioning

confidence: 97%

“…P1 patients were older than P2 patients (average P1 age, 66.6 years [standard deviation, or SD,18.9] versus 57 years [SD, 16.1] for P2 patients; P Ͻ 0.01); patient characteristics were otherwise similar in both periods. Table 1 represents the characteristics of ESBL E. coli strains carried in P1 and P2 patients.…”

mentioning

confidence: 99%

Prospective Cohort Study of the Relative Abundance of Extended-Spectrum-Beta-Lactamase-Producing Escherichia coli in the Gut of Patients Admitted to Hospitals

Lastours

Jacquier

d’Humières

et al. 2016

Antimicrob Agents Chemother

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A total of 458 patients were prospectively included at hospital admission and screened for extended-spectrum-beta-lactamaseproducing (ESBL) Escherichia coli carriage in 2007 and in 2010 to 2012. A 4-fold increase in ESBL carriage (3% to 12%), a 5-fold increase in numbers of community patients among ESBL carriers, and a higher number of multiple ESBL strains was found in the 2010 to 2012 period. ESBL E. coli represented the dominant E. coli strain (relative abundance, >50%) in 10/32 (31%) of ESBL carriers. This represents a major threat in terms of infectious risk and dissemination.T he epidemiology of Escherichia coli infections has recently been profoundly modified with the global emergence of strains resistant to third-generation cephalosporins (3GC), specifically, strains producing extended-spectrum ␤-lactamases (ESBL), in both hospitals and the community (1). CTX-M-type ESBLs, which have spread in a polyclonal manner on all continents, constitute a major public health concern worldwide (1).Gut colonization is the first step toward infections by E. coli (2). Recently, it has been shown that a high relative abundance (RA) of ESBL E. coli in the feces increases the risk of urinary tract infection (UTI) by ESBL E. coli (3). Additionally, a high ESBL E. coli RA has been associated with longer fecal carriage time, increasing the numbers of excreted E. coli in the environment and the potential risk of dissemination of these resistant strains (4). However, most studies focusing on ESBL fecal carriage have described the presence or absence of ESBL E. coli in the gut but have lacked quantitative data. Moreover, whether the ESBL populations are dominant was not specified. Here, we characterized and determined the prevalence, bacterial load, and diversity of ESBL E. coli in the gut of patients at hospital admission at two different time periods and determined factors associated with high relative abundance of ESBL carriage.We used samples collected in two previous prospective clinical trials (5, 6) (https://clinicaltrials.gov/ct2/show/NCT00520715 and https://clinicaltrials.gov/ct2/show/NCT01209247). In both works, clinical data (age, sex, Charlson comorbidity index, hospitalization ward, history of immunosuppression, previous hospitalization in the last 12 months, previous antibiotic exposure in the last 3 months, and antibiotic class) as well as a rectal swab had been collected from patients at admission in the same two tertiarycare hospitals from the Paris region in France (5, 6). The first collection period (P1) was between May and November 2007, and the second period (P2) was between October 2010 and July 2012. Both studies were approved by the local institutional review board (IRB 00008522), and patients gave informed consent (5, 6). Rectal swabs were discharged in 1 ml of brain heart infusion (BHI) broth with glycerol and stored at Ϫ80°C in duplicates (5, 6). After thawing, 50 l was plated on Drigalski agar plates (Pasteur Diagnostics, Paris, France), one containing no antibiotics and one containing 1 g/ml cefotax...

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“…A few studies have related resistance, using treatment resistance breakpoints; to post-operative infection (14)(15)(16)(17)(18)(19). The main area this has been investigated is liver transplantation, it is assumed this relates to the potentially high mortality rate associated with post-operative infections.…”

Section: Clinical Studies Into Antibiotic Resistance and Surgical Promentioning

confidence: 99%

“…The main area this has been investigated is liver transplantation, it is assumed this relates to the potentially high mortality rate associated with post-operative infections. The most informative study, by Bert et al, showed that pre-operative colonisation with ESBL Enterobacteriaceae increased the rate of post operative ESBL infections, although the overall infection rate was not reported (14). Within surgical biopsies of the prostate, another situation where prophylaxis is used, colonisation with ciprofloxacin resistant Enterobacteriaceae has been shown to indicate a higher risk of post-operative infection, 7.1% vs. 1.1%, in those not colonised (17).…”

Section: Clinical Studies Into Antibiotic Resistance and Surgical Promentioning

confidence: 99%

Antibiotic resistance in Enterobacteriaceae: what impact on the efficacy of antibiotic prophylaxis in colorectal surgery?

Kirby

Santoni

2015

Journal of Hospital Infection

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SummaryAntibiotic prophylaxis, introduced in the 1940s, brought in an era of relatively safe colorectal surgery. This was achieved in part due to the prevention of Enterobacteriaceae Surgical Site Infections (SSIs). Since then, Enterobacteriaceae have become increasingly resistant to antibiotics commonly used for prophylaxis. The impact of being colonised pre-operatively with a resistant Enterobacteriaceae on the efficacy of colorectal SSI prophylaxis, if any, is unknown. It is also difficult to predict the likely impact of resistance as the exposureresponse relationships are not determined for antibiotic surgical prophylaxis. Neither is it known which is the right test to determine if resistance is present as the importance of the concentration of Enterobacteriaceae in the colon, the ability of different species of Enterobacteriaceae to cause SSIs, and the comparative ability of MIC or presence of a resistance mechanism in predicting SSI risk have yet to be established. Clinical research is urgently needed to answer these questions.

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Pretransplant Fecal Carriage of Extended-Spectrum β-Lactamase–producingEnterobacteriaceaeand Infection after Liver Transplant, France

Cited by 95 publications

References 34 publications

Severe Sepsis Facilitates Intestinal Colonization by Extended-Spectrum-β-Lactamase-Producing Klebsiella pneumoniae and Transfer of the SHV-18 Resistance Gene to Escherichia coli during Antimicrobial Treatment

Severe Sepsis Facilitates Intestinal Colonization by Extended-Spectrum-β-Lactamase-Producing Klebsiella pneumoniae and Transfer of the SHV-18 Resistance Gene to Escherichia coli during Antimicrobial Treatment

Prospective Cohort Study of the Relative Abundance of Extended-Spectrum-Beta-Lactamase-Producing Escherichia coli in the Gut of Patients Admitted to Hospitals

Antibiotic resistance in Enterobacteriaceae: what impact on the efficacy of antibiotic prophylaxis in colorectal surgery?

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