Dynamics of colistin and tobramycin resistance among Enterobacter cloacae during prolonged use of selective decontamination of the digestive tract

Abstract

BackgroundA high prevalence of colistin resistance among E. cloacae isolates in two intensive care units (ICU) (of 16 and 6 beds) using selective digestive decontamination (SDD) since 1990 instigated a retrospective and prospective investigation to quantify the role of clonal transmission. SDD is topical application of colistin and tobramycin and systemic use of cefotaxime during the first days of ICU-admission.MethodsMulti-resistant E. cloacae (MREb) was defined as ESBL production and/or tobramycin non-susceptibility and/or colistin non-susceptibility. Incidence of acquisition and prevalence of carriage with MREb was determined from microbiological culture results.ResultsColistin-resistant E. cloacae was first detected in November 2009 and carriage was demonstrated in 141 patients until October 2014. Mean incidence of MREb acquisition was 4.61 and 1.86 per 1000 days at risk in ICUs 1 and 2, respectively, and the mean monthly prevalence of MREb in both ICUs was 7.0 and 3.1%, respectively, without a discernible trend in time. Conversion rates from carriage of colistin-susceptible to resistant E. cloacae were 0.20 and 0.13 per 1000 patient days, respectively. Whole genome sequencing of 149 isolates revealed eight clusters, with the number of SNPs of the largest two clusters ranging between 0 and 116 for cluster 1 (n = 49 isolates), and 0 and 27 for cluster 2 (n = 36 isolates), among isolates derived between 2009 and 2014.ConclusionsThis study demonstrates a stable low-level endemicity of MREb in two Dutch ICUs with prolonged use of SDD, which was characterized by the persistent presence of two clusters, suggesting incidental clonal transmission.Electronic supplementary materialThe online version of this article (10.1186/s13756-018-0356-7) contains supplementary material, which is available to authorized users.

Enterobacter spp.: Update on Taxonomy, Clinical Aspects, and Emerging Antimicrobial Resistance

“…This type of chromosomal mutation that efficiently alters the OM structure and generates a noticeable decrease of polymyxin activity may be involved in the emergence of resistant strains devoid of mcr-1 and mcr-2 (247). Moreover, the dynamic of colistin resistance in E. cloacae during selective decontamination of the digestive tract in intensive care units has been recently reported, suggesting a possible clonal transmission (286).…”

Long-term effectiveness of commonly used hospital disinfectants against Pseudomonas aeruginosa and Staphylococcus aureus

“…They have also caused rheumatoid arthritis, meningitis in infants, and wound infection (Hasan et al, 2021). Enterobacter species on the other hand are known to cause a wide range of hospital acquired infections including but not limited to those that affect the urinary tract, the lungs, intraabdominal cavity (Toleti et al, 2015;Dautzenberg et al, 2018). E. sakazakii causes meningitis and neonatal sepsis (Elkhawaga et al, 2020).…”

Is systematic fecal carriage screening of extended-spectrum beta-lactamase-producing Enterobacteriaceae still useful in intensive care unit: a systematic review

“…Selective decontamination is an attractive approach but, as previously described, its efficacy for ESBL-E decontamination still needs to be proven. Moreover, some concerns are already raised about the emergence of resistance to used antimicrobials such as colistin and tobramycin [75–77]. One of these studies even showed the emergence of ESBL-E when 3CG are used for selective decontamination [77].…”