Decreased transmission of Enterobacteriaceae with extended-spectrum β-lactamases in an intensive care unit by nursing reorganization

Soulier, A.; Barbut, Frédéric; Ollivier, Jean; Petit, J. C.; Lienhart, A.

doi:10.1016/0195-6701(95)90163-9

Cited by 42 publications

(28 citation statements)

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“…Laboratory-based detection of patients infected or colonized with ESBL-producing organisms by active surveillance cultures is also important because it has proven useful to control and terminate prolonged nosocomial outbreaks (16,19,21,29). Asymptomatic gastrointestinal tract colonization with ESBL producers without signs of overt infection may frequently occur in endemic or hyperendemic settings in hospitals, and such patients may represent an important reservoir of these organisms (20,27). Moreover, patients who develop infections with ESBL-producing Enterobacteriaceae have been frequently documented as having prior gastrointestinal carriage with such organisms (15,21).…”

Section: Discussionmentioning

confidence: 99%

“…Examples of such media include Drigalski agar supplemented with cefotaxime (27), MacConkey agar supplemented with ceftazidime (20), and nutrient agar supplemented with ceftazidime, vancomycin, and amphotericin B (21). In recent years, chromogenic media were initially developed for the detection and presumptive identification of urinary tract pathogens (6,11) as well as for the improved isolation of Staphylococcus aureus from clinical specimens (5,10).…”

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confidence: 99%

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Evaluation of a New Selective Chromogenic Agar Medium for Detection of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae

et al. 2007

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Microbial resistance through extended-spectrum ␤-lactamase (ESBL) was first reported in the early 1980s in Europe and subsequently in the United States soon after the introduction of third-generation cephalosporins in clinical practice (12). Today, this resistance mechanism has emerged globally, and ESBL-producing Enterobacteriaceae are recognized worldwide as nosocomial pathogens of major importance (19,28). Many clinical microbiology laboratories have problems with the detection of ESBL-mediated resistance, and the recent emergence and spread of novel types of community-acquired ESBLs, such as the CTX-M enzymes (2, 4), have created additional challenges that further complicate the detection of this resistance mechanism (1, 13). Several phenotypic tests have been recommended for screening and confirmation of ESBLs, but these are usually performed on isolated organisms following culture and antibiotic susceptibility testing (7, 24).The failure to detect ESBL-mediated resistance has led to treatment failure (17, 26) and contributed to uncontrolled spread of ESBL-producing organisms (18). On the other hand, laboratory-based detection of patients infected or colonized by ESBL-producing organisms by surveillance cultures has proven useful to control and terminate nosocomial outbreaks (16,19,21).Various selective media have been proposed to assess the carriage of ESBL producers in stools. Examples of such media include Drigalski agar supplemented with cefotaxime (27), MacConkey agar supplemented with ceftazidime (20), and nutrient agar supplemented with ceftazidime, vancomycin, and amphotericin B (21). In recent years, chromogenic media were initially developed for the detection and presumptive identification of urinary tract pathogens (6, 11) as well as for the improved isolation of Staphylococcus aureus from clinical specimens (5, 10). Recently, selective antibiotic-containing chromogenic media have been made available for the rapid detection of methicillin-resistant S. aureus (9, 23). One of the great advantages of such chromogenic selective media is that they allow the rapid and reliable screening of methicillin-resistant S. aureus colonization directly from contaminated clinical specimens (14).The purpose of this study was to evaluate the sensitivity and specificity of a novel prototype of selective chromogenic agar medium (ESBL-Bx; bioMérieux, Marcy l'Etoile, France) that enables the detection and presumptive identification of ESBLproducing Enterobacteriaceae directly from clinical specimens. MATERIALS AND METHODS Specimens.A total of 644 clinical samples, including 561 stool, 63 lower respiratory tract (sputum, bronchial, or endotracheal aspirates), and 20 miscellaneous samples (wound swabs or ear-nose-throat specimens), were referred to our department for the screening of ESBL-producing organisms. The specimens originated from 460 patients who had been hospitalized in various wards (geriatric unit, general medicine, oncohematology, and general surgery departments) for more than 48 h.Inoculation of media and i...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Evaluation of a New Selective Chromogenic Agar Medium for Detection of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae

et al. 2007

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“…Two other isolates produced two ESBLs simultaneously, having PI 6.3 and 7.0 types. Strains with two ESBLs are infrequent, but have been described several times [39-411. Intestinal colonisation may provide a reservoir for nosocomial klebsiella infections [42], and gut colonisation is frequent among patients in intensive care units [7,24,251. In addition to strict hygienic practices, intestinal decontamination with non-absorbed antibiotics was recommended for controlling this problem [43].…”

Section: Discussionmentioning

confidence: 99%

“…They have been responsible for outbreaks, particularly in intensive care units and in chronic care facilities, but have occasionally spread also to medical and surgical wards [7-131. Hospital colonisation by ESBL-producing bacteria can reflect dissemination of a few clones, or the spread of plasmids and resistance genes [13][14][15][16][17][18][19][20][21], facilitated by antibiotic pressure and inadequate infection-control practice [9-10, [22][23][24]. Several outbreaks of nosocomial infections caused by ESBL-producing K. pneumoniae occurred in our hospital between 1988 and 199 1.…”

Section: Introductionmentioning

confidence: 99%

Long-term investigation of the clonal dissemination of Klebsiella pneumoniae isolates producing extended-spectrum -lactamases in a university hospital

Branger

Lesimple²,

Berry³

et al. 1998

Journal of Medical Microbiology

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Seventy isolates of Klebsiellu pneumoniae with extended-spectrum /3-lactamases (ESBLs) were compared. These were isolated from 51 patients on 10 separate wards in one hospital over an 18-month period between 1992 and 1994. Antibiograms were determined and the isolates were typed by pulsed-field gel electrophoresis of their DNA digestion with Xbu I. The isolates were compared to three genotypically different epidemic strains responsible for previous outbreaks at the hospital between 1988 and 1991. Isolates from 84% of the present patients had closely related Xbul patterns, and most (74%) produced an ESBL with an iso-electric point (PI) of 7.0. A similar pattern was found for one of the previous epidemic strains, but it produced an ESBL with a PI of 7.8; isolates with this latter enzyme variant were found only in six of the present patients. The two other previous epidemic strains had ESBLs with a PI of 6.3 and organisms related to them were found in one and two of the present patients, respectively.

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“…The use of artificial nails may also promote longterm carriage and has been associated with at least one outbreak (152). Gastrointestinal tract carriage has been documented in health care workers (131,166,378), but is astonishingly rare and seldom prolonged, except with ESBLproducing Salmonella species (157,247).…”

Section: Modes Of Spread Of Esbl-producing Organisms Within Hospitalsmentioning

confidence: 99%

Extended-Spectrum β-Lactamases: a Clinical Update

2005

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SUMMARY Extended-spectrum β-lactamases (ESBLs) are a rapidly evolving group of β-lactamases which share the ability to hydrolyze third-generation cephalosporins and aztreonam yet are inhibited by clavulanic acid. Typically, they derive from genes for TEM-1, TEM-2, or SHV-1 by mutations that alter the amino acid configuration around the active site of these β-lactamases. This extends the spectrum of β-lactam antibiotics susceptible to hydrolysis by these enzymes. An increasing number of ESBLs not of TEM or SHV lineage have recently been described. The presence of ESBLs carries tremendous clinical significance. The ESBLs are frequently plasmid encoded. Plasmids responsible for ESBL production frequently carry genes encoding resistance to other drug classes (for example, aminoglycosides). Therefore, antibiotic options in the treatment of ESBL-producing organisms are extremely limited. Carbapenems are the treatment of choice for serious infections due to ESBL-producing organisms, yet carbapenem-resistant isolates have recently been reported. ESBL-producing organisms may appear susceptible to some extended-spectrum cephalosporins. However, treatment with such antibiotics has been associated with high failure rates. There is substantial debate as to the optimal method to prevent this occurrence. It has been proposed that cephalosporin breakpoints for the Enterobacteriaceae should be altered so that the need for ESBL detection would be obviated. At present, however, organizations such as the Clinical and Laboratory Standards Institute (formerly the National Committee for Clinical Laboratory Standards) provide guidelines for the detection of ESBLs in klebsiellae and Escherichia coli. In common to all ESBL detection methods is the general principle that the activity of extended-spectrum cephalosporins against ESBL-producing organisms will be enhanced by the presence of clavulanic acid. ESBLs represent an impressive example of the ability of gram-negative bacteria to develop new antibiotic resistance mechanisms in the face of the introduction of new antimicrobial agents.

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Decreased transmission of Enterobacteriaceae with extended-spectrum β-lactamases in an intensive care unit by nursing reorganization

Cited by 42 publications

References 21 publications

Evaluation of a New Selective Chromogenic Agar Medium for Detection of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae

Evaluation of a New Selective Chromogenic Agar Medium for Detection of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae

Long-term investigation of the clonal dissemination of Klebsiella pneumoniae isolates producing extended-spectrum -lactamases in a university hospital

Extended-Spectrum β-Lactamases: a Clinical Update

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