Detection and Treatment of Antibiotic-Resistant Bacterial Carriage in a Surgical Intensive Care Unit: A 6-Year Prospective Survey

Troché, Gilles; Joly, Luc‐Marie; Guibert, M.; Zazzo, Jean‐Fabien

doi:10.1086/502521

Cited by 79 publications

(47 citation statements)

References 20 publications

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“…ESBL infections are associated with colonization [19][20][21][22] and, independent of the infection site, the digestive tract seems to be the main reservoir from which ESBLs are derived [19,23,24]. In this systematic review and metaanalysis, we estimate the prevalence of ESBL class A colonization among healthy patients and assess the factors that are associated with the colonization status.…”

mentioning

confidence: 99%

Fecal Colonization With Extended-spectrum Beta-lactamase–ProducingEnterobacteriaceaeand Risk Factors Among Healthy Individuals: A Systematic Review and Metaanalysis

Karanika¹,

Karantanos²,

Arvanitis³

et al. 2016

Clin Infect Dis.

379

280

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Background. Gut colonization is a risk factor for infections with extended-spectrum beta-lactamase (ESBL)-producing organisms. We aimed to determine the ESBL class A reservoir among healthy individuals.Methods. We searched PubMed and EMBASE (through 10 July 2015) looking for studies that contained data for fecal colonization with ESBL class A bacteria among healthy individuals for each World Health Organization-defined region. Distribution of isolates among cefotaximase (CTX-M), sulfhydryl variable, and temoneira enzymes and data on previous antibiotic use, international travel, previous hospitalization, and animal contacts were extracted.Results. Sixty-six of 17 479 studies on 28 909 healthy individuals were included. The pooled prevalence of ESBL class A colonization was 14% (95% confidence interval [CI],9,20), with an increasing trend of 5.38% annually (P = .003). The pooled prevalence was higher in Asia and Africa (ranging from 46%, 95% CI, 29, 63 to 15%, 95% CI, 4, 31) and lower but still significant in central (3%, 95% CI, 1, 5), northern (4%, 95% CI, 2, 6), and southern Europe (6%, 95% CI, 1, 12) and the Americas (2%, 95% CI, 0, 5). CTX-Ms were the prevalent ESBL enzyme (69%). Antibiotic use for the prior 4 or 12 months was associated with a high colonization risk (risk ratio [RR] = 1.63; 95% CI, 1.19, 2.24 and RR = 1.58; 95% CI, 1.16, 2.16, respectively). International travel was also correlated with ESBL colonization [(RR = 4.06, (95% CI, 1.33, 12.41)].Conclusions. The ESBL colonization rate among healthy individuals is significant worldwide. This should be taken into consideration in infection control and antibiotic management decisions.

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confidence: 99%

Fecal Colonization With Extended-spectrum Beta-lactamase–ProducingEnterobacteriaceaeand Risk Factors Among Healthy Individuals: A Systematic Review and Metaanalysis

Karanika¹,

Karantanos²,

Arvanitis³

et al. 2016

Clin Infect Dis.

379

280

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“…18 Several attempts to control nosocomial outbreaks of infections with resistant organisms using gut decontamination were also reported. 24,25 Oral gentamicin is a common component of the selective digestive tract decontamination regimen. Beginning with 2006, our hospital, as almost all major hospitals in Israel, observed continuous increase in clinical isolates of CRKP.…”

Section: Discussionmentioning

confidence: 99%

SCT in patients with carbapenem resistant Klebsiella pneumoniae: a single center experience with oral gentamicin for the eradication of carrier state

Zuckerman

Benyamini

Sprecher

et al. 2010

Bone Marrow Transplant

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Following an outbreak of carbapenem resistant Klebsiella pneumoniae (CRKP) bacteremia among inpatients in the Hemato-oncology and BMT unit, we studied the course of this infection in patients undergoing intensive chemotherapy and SCT. In addition, we conducted a pilot study aimed to eradicate CRKP colonization in the gastrointestinal tract, using oral gentamicin. Adult patients admitted to the BMT unit, identified as CRKP carriers on surveillance rectal cultures, were included in the study. Oral gentamicin at a dose of 80 mg q.i.d. was administered to all identified carriers until eradication. Among 15 colonized patients included in the study, the eradication rate achieved was 66% (10/15); discontinuation of persistent bacteremia occurred in 62.5% (5/8) and nosocomial spread of CRKP carrier state ceased. Administration of intensive chemotherapy and SCT is feasible, although associated with increased risk. Hematological patients in need of intensive chemotherapy/SCT should not be denied the required treatment on the basis of being CRKP carriers. Oral gentamicin treatment for eradication of CRKP from the gastrointestinal reservoir could serve as additional tool in the combat against the nosocomial spread and severe infections caused by this difficult-to-treat organism.

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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).…”

Section: Discussionmentioning

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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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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Detection and Treatment of Antibiotic-Resistant Bacterial Carriage in a Surgical Intensive Care Unit: A 6-Year Prospective Survey

Cited by 79 publications

References 20 publications

Fecal Colonization With Extended-spectrum Beta-lactamase–ProducingEnterobacteriaceaeand Risk Factors Among Healthy Individuals: A Systematic Review and Metaanalysis

Fecal Colonization With Extended-spectrum Beta-lactamase–ProducingEnterobacteriaceaeand Risk Factors Among Healthy Individuals: A Systematic Review and Metaanalysis

SCT in patients with carbapenem resistant Klebsiella pneumoniae: a single center experience with oral gentamicin for the eradication of carrier state

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

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