Dramatic Increase in Prevalence of Fecal Carriage of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae during Nonoutbreak Situations in Spain

Abstract

The occurrence of extended-spectrum ␤-lactamase (ESBL)-producing isolates has increased worldwide. Fecal carriage of ESBL-producing isolates has mainly been detected in nosocomial outbreaks, and few studies have evaluated fecal carriage during nonoutbreak situations and among patients in the community. We have studied the prevalence of ESBLs in 1,239 fecal samples from 849 patients (64.1% of whom were ambulatory) in 1991 and have compared the prevalence data with those obtained in 2003 for 400 fecal samples from 386 patients (75.9% of whom were ambulatory) and 108 samples from independent healthy volunteers. Samples were diluted in saline and cultured in two MacConkey agar plates supplemented with ceftazidime (1 g/ml) and cefotaxime (1 g/ml), respectively. Colonies were screened (by the double-disk synergy test) for ESBL production. The clonal relatedness of all ESBL-producing isolates was determined by pulsed-field gel electrophoresis with XbaI digestion; and the ESBLs of all ESBL-producing isolates were characterized by isoelectric focusing, PCR, and sequencing. The rates of fecal carriage of ESBL-producing isolates increased significantly (P < 0.001) in both hospitalized patients and outpatients, from 0.3 and 0.7%, respectively, in 1991, to 11.

Diversity of genotypes in CTX-M-producing Klebsiella pneumoniae isolated in different hospitals in Brazil

“…CTX-M-2 was first characterized and appears to be dominant in Argentina. 20 Studies carried out in Europe have shown that the occurrence of the bla CTX-M-2 group is rare. Recent studies in Southeast Brazil have demonstrated the presence of bla CTX-M-2 gene in K. Pneumoniae.…”

“…Resistance of ESBL-producing isolates to other classes of antimicrobial agents shown in this report has been confirmed by other studies. 5,20 Among Enterobacteriaceae, these resistance pattern was commonly associated with a few types of integrons.…”

Enterobactérias produtoras de ESBL em Passo Fundo, estado do Rio Grande do Sul, Brasil

“…Os principais gêneros produtores de ESBLs, dentre as enterobactérias, são Escherichia coli, Klebsiella pneumoniae, Proteus sp, Providencia sp e Enterobacter sp 2 . Enterobactérias produtoras de ESBLs estão amplamente disseminadas, já tendo sido reportadas na França, Estados Unidos, Reino Unido, Grécia, Holanda, Hungria, Portugal, Bolívia, Peru, Brasil, entre outros [9][10][11][12][13] .…”

Hygienemaßnahmen bei Infektionen oder Besiedlung mit multiresistenten gramnegativen Stäbchen

“…Der Erreger löst Infektionen in der Regel nur in stark immunsupprimierten Patienten, vor allem Patienten mit soliden und hämatologischen Krebserkrankungen aus [20][21][22][23][24], bei denen die Infektion auch mit einer nennenswerten Letalität verbunden ist [20][21][22][23][24][25] [41].…”