Concomitant dissemination of three extended-spectrum β-lactamases among different Enterobacteriaceae isolated in a French hospital

Champs, Christophe de; Sirot, D.; Chanal, C.; Poupart, M C; Dumas, Marie-Paule; Sirot, J.

doi:10.1093/jac/27.4.441

Cited by 108 publications

(98 citation statements)

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“…Not all individuals who are colonized with ARB are persistently colonized; common wisdom holds that humans may be persistent, intermittent, or noncarriers of various strains of bacteria (30). Some qualitative information about persistence times are available for MRSA (31)(32)(33)(34), VRE (5,(35)(36)(37), Escherichia coli, (38), Pseudomonas aeruginosa (39), Klebsiella pneumoniae (40,41), and other enterobacteria (42). These studies suggest that carriage for months or years is not uncommon.…”

Section: Discussionmentioning

confidence: 99%

Persistent colonization and the spread of antibiotic resistance in nosocomial pathogens: Resistance is a regional problem

Smith

Dushoff

Perencevich

et al. 2004

Proc. Natl. Acad. Sci. U.S.A.

175

116

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Infections with antibiotic-resistant bacteria (ARB) in hospitalized patients are becoming increasingly frequent despite extensive infection-control efforts. Infections with ARB are most common in the intensive care units of tertiary-care hospitals, but the underlying cause of the increases may be a steady increase in the number of asymptomatic carriers entering hospitals. Carriers may shed ARB for years but remain undetected, transmitting ARB to others as they move among hospitals, long-term care facilities, and the community. We apply structured population models to explore the dynamics of ARB, addressing the following questions: (i) What is the relationship between the proportion of carriers admitted to a hospital, transmission, and the risk of infection with ARB? (ii) How do frequently hospitalized patients contribute to epidemics of ARB? (iii) How do transmission in the community, long-term care facilities, and hospitals interact to determine the proportion of the population that is carrying ARB? We offer an explanation for why ARB epidemics have fast and slow phases and why resistance may continue to increase despite infection-control efforts. To successfully manage ARB at tertiary-care hospitals, regional coordination of infection control may be necessary, including tracking asymptomatic carriers through health-care systems

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Section: Discussionmentioning

confidence: 99%

Persistent colonization and the spread of antibiotic resistance in nosocomial pathogens: Resistance is a regional problem

Smith

Dushoff

Perencevich

et al. 2004

Proc. Natl. Acad. Sci. U.S.A.

175

116

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“…have replaced Klebsiella pneumoniae as the third leading cause of gram-negative nosocomial infections, particularly nosocomial pneumonias, after Escherichia coli and Pseudomonas aeruginosa [2-51. Of particular concern is the ability of E. aerogenes to develop resistance to broad-spectrum p-lactam agents by the production of an extended-spectrum P-lactamase (ESBL) [6,7]. This species is part of the normal flora of the gastrointestinal tract and is, in some cases, a stable skin resident [8].…”

Section: Introductionmentioning

confidence: 99%

“…This species is part of the normal flora of the gastrointestinal tract and is, in some cases, a stable skin resident [8]. Reports concerning opportunist infections with E. aerogenes in hospitalised or debilitated patients first appeared in 1986 [2,7].…”

Section: Introductionmentioning

confidence: 99%

Investigation of outbreaks of Enterobacter aerogenes colonisation and infection in intensive care units by random amplification of polymorphic DNA

Davin-Régli¹,

Saux²,

Bollet³

et al. 1996

Journal of Medical Microbiology

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During a 4-month period, 41 isolates of Enferobacfer aerogenes were cultured from different specimens from a 14-bed intensive care unit (ICUl). These were obtained from 12 patients out of a total of 187 patients admitted to the ICU. Sixteen E. aerogenes isolates were cultured from another ICU (ICU2) 6 months later. Six non-outbreakassociated strains were included as controls and all the isolates were compared by random amplification of polymorphic DNA (RAPD), with three different 10-mer oligonucleotide primers. The six non-outbreak-associated strains were distinguishable by RAPD with two of the three primers. RAPD fingerprinting with primer AP12h was as discriminatory as the combined results from all three primers and defined 22 different patterns for the 41 isolates from the ICU1. In nine instances, isolates with indistinguishable RAPD patterns were detected in two-to-five patients over a 3-15-day period, suggesting patient-to-patient transmission. During their stay in ICU1, patients harboured one-to-12 distinguishable isolates. Isolates from ICU2 were indistinguishable by RAPD analysis with the three different primers. These findings suggest that the cluster of colonisations and infections in ICUl was a 'false outbreak', consisting of successive patient-to-patient transmission of different E. aerogenes strains. In contrast, the outbreak on ICU2 probably involved the extensive spread of a single strain.

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“…In some patient populations, the derepressed production of the AmpC beta-lactamase is a mechanism of beta-lactam resistance in E. cloacae strains (25,28). However, the occurrence of extended-spectrum beta-lactamases (ESBLs) in members of the family Enterobacteriaceae that possess inducible Bush group 1 chromosomal beta-lactamases is also increasingly reported worldwide (1,3,4,5,6,8,12).A 4-month survey was carried out to evaluate the prevalence of diverse ESBLs among E. cloacae isolates in HuaShan Hospital, Shanghai, People's Republic of China. This study identified a novel VEB-type ESBL, VEB-3.…”

mentioning

confidence: 99%

Outbreak of Infection Caused by Enterobacter cloacae Producing the Novel VEB-3 Beta-Lactamase in China

Jiang

et al. 2005

J Clin Microbiol

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ceftazidime-resistant or cefotaxime-resistant nonrepetitive Enterobacter cloacae isolates were collected from 27 patients hospitalized at HuaShan Hospital, Shanghai, People's Republic of China. The Etest did not detect extended-spectrum beta-lactamases (ESBLs) in those 27 isolates; however, screening by the NCCLS ESBL disk test and confirmatory tests detected ESBLs in 4 of 27 isolates and PCR detected ESBLs in 23 of 27 isolates. The majority of ESBL producers exhibited the same repetitive extragenic palindromic PCR pattern but harbored different ESBL genes. CTX-M-3 was the most prevalent ESBL in our study. Interestingly, 12 clonally related E. cloacae isolates possessed a novel bla VEB -type beta-lactamase, bla VEB-3 . Bla VEB-3 was encoded by the chromosome and was located in an integron. Nine of the 12 isolates harbored both the bla VEB-3 and the bla CTX-M-3 -like ESBLs. This is the first report of a VEB-1-like ESBL in China and the first report of the simultaneous presence of VEB-1 and CTX-M-3-like ESBLs in an isolate.Enterobacter cloacae is an important opportunistic pathogen known to cause nosocomial septicemia and urinary tract and respiratory tract infections (9, 25). Reports of multidrug-resistant isolates have increased during the last decade, probably as a result of the extensive use of broad-spectrum antibiotics. In some patient populations, the derepressed production of the AmpC beta-lactamase is a mechanism of beta-lactam resistance in E. cloacae strains (25,28). However, the occurrence of extended-spectrum beta-lactamases (ESBLs) in members of the family Enterobacteriaceae that possess inducible Bush group 1 chromosomal beta-lactamases is also increasingly reported worldwide (1,3,4,5,6,8,12).A 4-month survey was carried out to evaluate the prevalence of diverse ESBLs among E. cloacae isolates in HuaShan Hospital, Shanghai, People's Republic of China. This study identified a novel VEB-type ESBL, VEB-3. This is also the first report of VEB-1-like ESBLs from nosocomial isolates in the People's Republic of China. The first reported VEB-type ESBL, VEB-1, was detected in Pseudomonas aeruginosa strains from Southeast Asia (22). Unlike most of the ESBL genes, bla VEB-1 is part of a gene cassette and is located in class 1 integrons of various structures (10,11,15,16). MATERIALS AND METHODSBacterial isolates. Twenty-seven nonrepetitive ceftazidime-resistant or cefotaxime-resistant E. cloacae clinical isolates were consecutively collected in the bacteriology laboratory of the Center of Laboratory Medicine, Huashan Hospital, Shanghai, from November 2002 to February 2003. During this period, 58 isolates of the species were obtained from patient specimens (22 from sputum, 22 from urine, 6 from blood, and 8 from other specimens). The isolates were identified with the API 20E system (bioMerieux SA, Marcy-1ЈEtoile, France). Escherichia coli ATCC 25922 was used as a negative control. Klebsiella pneumoniae ATCC 700603 was used as an ESBL-positive control. E. cloacae 029 and E. cloacae 029 M were used as control strai...

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Concomitant dissemination of three extended-spectrum β-lactamases among different Enterobacteriaceae isolated in a French hospital

Cited by 108 publications

References 0 publications

Persistent colonization and the spread of antibiotic resistance in nosocomial pathogens: Resistance is a regional problem

Persistent colonization and the spread of antibiotic resistance in nosocomial pathogens: Resistance is a regional problem

Investigation of outbreaks of Enterobacter aerogenes colonisation and infection in intensive care units by random amplification of polymorphic DNA

Outbreak of Infection Caused by Enterobacter cloacae Producing the Novel VEB-3 Beta-Lactamase in China

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