Screening at admission for carrier prevalence of multidrug-resistant organisms in a pediatric unit

Tarchouna, Mouna; Ferjani, Asma; Tilouche, S; Marzouk, Manel; Bouguila, Jihéne; Boughamoura, Lamia; Boukadida, Jalel

doi:10.1016/j.ajic.2013.07.008

Cited by 6 publications

(9 citation statements)

References 7 publications

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“…The main finding from this 3-month study is the high rate of fecal carriage of CTX-R Enterobacteriaceae at ICU admission (20.63%), with K. pneumoniae representing the most common CTX-R Enterobacteriaceae species recovered (76.92%) especially for the acquired-carriage; which is in accordance with previous studies (Thiébaut et al, 2012; Tarchouna et al, 2014). These MDR bacteria were probably selected during hospitalization preceding ICU transfer; however, a community origin cannot be eliminated.…”

Section: Discussionsupporting

confidence: 92%

“…In Tunisia, the fecal carriage of ESBL-producing Enterobacteriaceae (ESBL-E) was reported in three previous studies: one investigated children hospitalized in a pediatric unit, one concerning healthy adults and another about healthy children (Ben Sallem et al, 2012; Tarchouna et al, 2014; Sana et al, in press). All these findings raise the question of asymptomatic carriage of this pathogen not only in the hospital settings but also in the community, which enhances the spread of resistance genes by transmission from human-to-human, patients-to-others and medical staff-to-patients or contamination of the environment in our country.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple investigators reported that most colonizing ESBL-E isolates were K. pneumoniae in high-risk patients and associated with hospital-onset infections, whereas E. coli was frequently isolated in healthy individuals and was the predominant cause of community-onset infections (Ben Sallem et al, 2012; Ko et al, 2013; Tarchouna et al, 2014). …”

Section: Discussionmentioning

confidence: 99%

“…In Tunisia, investigations of fecal carriage of MDR bacteria are rare (Ben Sallem et al, 2012; Tarchouna et al, 2014; Sana et al, in press). The present prospective study aimed to determine the prevalence of CTX-R Enterobacteriaceae -intestinal carriage in patients newly admitted at the ICU of Charles Nicolle hospital, to evaluate the rate of acquisition of these organisms during their ensuing hospitalization, and to explore some of the associated risk factors for both carriage and acquisition.…”

Section: Introductionmentioning

confidence: 99%

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High Prevalence of Gut Microbiota Colonization with Broad-Spectrum Cephalosporin Resistant Enterobacteriaceae in a Tunisian Intensive Care Unit

et al. 2016

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Healthcare-associated infections due to cefotaxime-resistant (CTX-R) Enterobacteriaceae have become a major public health threat, especially in intensive care units (ICUs). Often acquired nosocomially, CTX-R Enterobacteriaceae can be introduced initially by patients at admission. This study aimed to determine the prevalence and genetic characteristics of CTX-R Enterobacteriaceae-intestinal carriage in ICU patients, to evaluate the rate of acquisition of these organisms during hospitalization, and to explore some of the associated risk factors for both carriage and acquisition. Between December 2014 and February 2015, the 63 patients admitted in the ICU of Charles Nicolle hospital were screened for rectal CTX-R Enterobacteriaceae colonization at admission and once weekly thereafter to identify acquisition. CTX-R Enterobacteriaceae fecal carriage rate was 20.63% (13/63) at admission. Among the 50 non-carriers, 35 were resampled during their hospitalization and the acquisition rate was 42.85% (15/35). Overall, 35 CTX-R Enterobacteriaceae isolates were collected from 28 patients (25 Klebsiella pneumoniae, seven Escherichia coli, and three Enterobacter cloacae strains). Seven patients were simultaneously colonized with two CTX-R Enterobacteriaceae isolates. CTX-M-15 was detected in most of the CTX-R Enterobacteriaceae isolates (30/35, 88.23%). Three strains co-produced CMY-4 and 22 strains were carbapenem-resistant and co-produced a carbapenemase [OXA-48 (n = 13) or NDM-1 (n = 6)]. Molecular typing of K. pneumoniae strains, revealed eight Pulsed field gel electrophoresis (PFGE) patterns and four sequence types (ST) [ST101, ST147, ST429, and ST336]. However, E. coli isolates were genetically unrelated and belonged to A (n = 2), B1 (n = 2) and B2 (n = 3) phylogenetic groups and to ST131 (two strains), ST572 (two strains), ST615 (one strain) and ST617 (one strain). Five colonized patients were infected by CTX-R Enterobacteriaceae (four with the same strain identified from their rectal swab and one with a different strain). Whether imported or acquired during the stay in the ICU, colonization by CTX-R Enterobacteriaceae is a major risk factor for the occurrence of serious nosocomial infections. Their systematic screening in fecal carriage is mandatory to prevent the spread of these multidrug resistant bacteria.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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High Prevalence of Gut Microbiota Colonization with Broad-Spectrum Cephalosporin Resistant Enterobacteriaceae in a Tunisian Intensive Care Unit

et al. 2016

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“…Among EPEC isolates, (40/87) 45.97 percent isolates, showed MDR phenotype with higher antibiotic resistance to cefotaxime followed by gentamicin, ampicillin, norfloxacin, amikacin, Piperacillin+tazobactam, imipenem, nalidixic acid, ciprofloxacin, as reported by others (Saravanan and Raveendaran, 2013; Lin et al, 2014; Wang et al, 2015). Such high cefotaxime-resistant (CTX-R) population of enterobacteriaceae, constitute a reservoir for transmission that may remain unidentified in hospitals which do not implement active surveillance testing (Tarchouna et al, 2014). In our study, less than half of the isolates were multidrug resistant (45.83%) which has also been reported by other workers (Elsharkawy et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Distribution of Integrons and Phylogenetic Groups among Enteropathogenic Escherichia coli Isolates from Children <5 Years of Age in Delhi, India

et al. 2017

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Integrons by means of horizontal gene transfer carry multidrug resistance genes (MDR) among bacteria, including E. coli. The aim of this study was to determine the antibiotic resistance profiles and the genes associated with them, to gain insights in the distribution of phylogroups, prevalence, and characterization of class 1, 2 and 3 integrons among Enteropathogenic E. coli (EPEC) isolates, from children upto 5 years of age from Delhi and National Capital Region (NCR), India. A total of 120 E. coli isolates, including 80 from diarrheagenic E. coli (cases) and 40 from healthy isolates (controls) were recruited in this study. After isolation of E. coli, screening for EPEC was done by conventional multiplex PCR. Antibiotic suseptibility test was performed using disk diffusion method and further confirmed by minimum inhibitory concentration (MICs) by E-test. The presence and characterization of integrons and antimicrobial resistance genes were performed by PCR and DNA sequencing. Phylogeny determination was carried out by quadruplex PCR. EPEC strains were found in 64 of the 80 diarrheagenic cases, out of which 38 were MDR. In the 40 healthy controls, 23 were found to be EPEC strain, out of which only 2 were MDR. Amongst 80 diarrheagenic cases, class 1 integron were observed in 43 isolates, class 2 integron in 12 isolates and 9 isolates were found with co-existence of both. Similarly, in healthy controls; class 1 integron in 9 and class 2 integron in 7 isolates were observed with co-existence in 3 isolates. None of the isolates included class 3 integron. The dfr was the most commonly identified gene cassette within the integron-positive isolates. Phylogenetic studies showed considerable representation of phylogroup B2 in both diarrheagenic cases and healthy controls. This study reiterates the importance of class 1 integron predominantly for acquisition of antibiotic resistance genes among EPEC isolates. Furthermore, it also ascertains the possible association between multidrug resistance and presence of integrons. Approximately 91% of isolates were easily assigned to their respective phylogroups. Assessment of the relationship between antibiotic resistance and dominant phylogroups detected was also attempted. This study also highlights the increased burden of antimicrobial resistance in healthy controls.

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Dissemination of multidrug-resistant blaCTX-M-15/IncFIIk plasmids in Klebsiella pneumoniae isolates from hospital- and community-acquired human infections in Tunisia

Mansour

Grami

Khalifa³

et al. 2015

Diagnostic Microbiology and Infectious Disease

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Screening at admission for carrier prevalence of multidrug-resistant organisms in a pediatric unit

Cited by 6 publications

References 7 publications

High Prevalence of Gut Microbiota Colonization with Broad-Spectrum Cephalosporin Resistant Enterobacteriaceae in a Tunisian Intensive Care Unit

High Prevalence of Gut Microbiota Colonization with Broad-Spectrum Cephalosporin Resistant Enterobacteriaceae in a Tunisian Intensive Care Unit

Distribution of Integrons and Phylogenetic Groups among Enteropathogenic Escherichia coli Isolates from Children <5 Years of Age in Delhi, India

Dissemination of multidrug-resistant blaCTX-M-15/IncFIIk plasmids in Klebsiella pneumoniae isolates from hospital- and community-acquired human infections in Tunisia

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