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

Davin-Régli, Anne; Saux, P.; Bollet, C.; Gouin, F; Micco, P. De

doi:10.1099/00222615-44-2-89

Cited by 21 publications

(28 citation statements)

References 26 publications

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“…Such observations suggest the sporadic or epidemic occurrence of a strain which has disseminated in France since the early 1990s (12,16) and more recently in a neighboring country, Belgium (19). Actually, the RAPD and ERIC-PCR typing methods, which have already been successfully used in previous studies (3,17,31), have confirmed that all of these 18 E. aerogenes isolates were identical to the clone prevalent throughout France and abroad. The extrahospital diffusion of this strain had previously been suspected, since patients were demonstrated to harbor it on admission to hospital (12), but the present study provides evidence for such an assumption.…”

Section: Discussionsupporting

confidence: 54%

Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Community and Private Health Care Centers

Arpin

Dubois

Coulange

et al. 2003

Antimicrob Agents Chemother

140

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In 1999, 39 of 2,599 isolates of the family Enterobacteriaceae (1.5%) collected by eight private laboratories in the Aquitaine region in France produced an extended-spectrum ␤-lactamase (ESBL). Among these were 19 Enterobacter aerogenes isolates; 8 Klebsiella pneumoniae isolates; 6 Escherichia coli isolates; 3 Proteus mirabilis isolates; and 1 isolate each of Serratia marcescens, Morganella morganii, and Providencia stuartii. ESBL producers were isolated from 38 patients, including 33 residents of 11 clinics or nursing homes and 5 ambulatory patients. Seven different ESBLs were characterized. These mainly consisted of TEM-24 (25 isolates) and TEM-21 (9 isolates), but TEM-15 (2 isolates) and TEM-3, TEM-19, SHV-4, and CTX-M-1 (1 isolate each) were also characterized. Seven strains showed the coexistence of different TEM-and/or SHV-encoding genes, including a new SHV-1 variant, SHV-44, defined by the substitution R205L previously reported for SHV-3 in association with S238G. The epidemiology of the ESBL producers was investigated by random amplification of polymorphic DNA, typing by enterobacterial repetitive intergenic consensus PCR, analysis of resistance cotransferred with the ESBL, and analysis of the restriction profiles of the ESBL-encoding plasmids. Of the TEM-24-expressing strains, 18 were E. aerogenes isolates, including 9 from the same clinic, that were representatives of the epidemic clone disseminating in France. Of the TEM-21-producing strains that belonged to different species of the family Enterobacteriaceae (E. coli, K. pneumoniae, and P. mirabilis), 8 were isolated in the same nursing home. Outbreaks due to strain and/or plasmid dissemination in these clinic and nursing home were demonstrated. The presence of ESBL producers in five ambulatory patients probably resulted from nosocomial acquisition. Our data highlight the serious need to monitor patients for ESBL-producing Enterobacteriaceae in general practice.

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Section: Discussionsupporting

confidence: 54%

Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Community and Private Health Care Centers

Arpin

Dubois

Coulange

et al. 2003

Antimicrob Agents Chemother

140

View full text Add to dashboard Cite

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“…The spread of epidemic strains from nursing homes to other units, especially surgical units and ICUs, can be suspected. ICUs, where patients have predisposing factors such as foreign devices, compromised immunity, and broad-spectrum antibiotic treatment, are considered to serve as breeding grounds for epidemic multidrug-resistant bacteria leading to outbreaks (2,4,12,13,15,21,23). The predominance of TEM-24-producing E. aerogenes among all of the ESBL-EA isolates found is probably due to virulence determinants such as antibiotic resistance or surface factors involved in epithelial cell surface adherence.…”

Section: Discussionmentioning

confidence: 99%

“…They were investigated by using molecular typing methods such as pulsed-field gel electrophoresis (PFGE) (2,15,24,32), random amplified polymorphic DNA analysis (4,8,12,13,23), enterobacterial repetitive intergenic consensus sequence PCR (ERIC-PCR) (8,13,15,21), and ribotyping (4,21,23). In some studies, the ␤-lactam resistance was characterized, giving ESBL identification (4,8,11,14,32,35).…”

mentioning

confidence: 99%

Coexistence of SHV-4- and TEM-24-Producing Enterobacter aerogenes Strains before a Large Outbreak of TEM-24-Producing Strains in a French Hospital

Mammeri¹,

Laurans²,

Eveillard³

et al. 2001

J Clin Microbiol

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In 1996, a monitoring program was initiated at the teaching hospital of Amiens, France, and carried out for 3 years. All extended-spectrum ␤-lactamase (ESBL)-producing Enterobacter aerogenes isolates recovered from clinical specimens were collected for investigation of their epidemiological relatedness by pulsed-field gel electrophoresis and enterobacterial repetitive intergenic consensus PCR (ERIC-PCR) and determination of the type of ESBL harbored by isoelectric focusing and DNA sequencing. Molecular typing revealed the endemic coexistence, during the first 2 years, of two clones expressing, respectively, SHV-4 and TEM-24 ESBLs, while an outbreak of the TEM-24-producing strain raged in the hospital during the third year, causing the infection or colonization of 165 patients. Furthermore, this strain was identified as the prevalent clone responsible for outbreaks in many French hospitals since 1996. This study shows that TEM-24-producing E. aerogenes is an epidemic clone that is well established in the hospital's ecology and able to spread throughout wards. The management of the outbreak at the teaching hospital of Amiens, which included the reinforcement of infection control measures, failed to obtain complete eradication of the clone, which has become an endemic pathogen.

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“…Until recently, E. cloacae was the species most frequently reported in nosocomial infections. Over the last 5 years, E. aerogenes has emerged as an agent of nosocomial infection, and multiresistant strains have caused outbreaks in intensive care units (ICUs) in Belgium (9, 13), France (2,6,7,12,19), Austria (1), and the United States (11). Recent national surveys have described the epidemiology of E. aerogenes in Belgium (23) and France (4,10).…”

Section: Among the Enterobacter Genus Enterobacter Cloacae Andmentioning

confidence: 99%

National Epidemiologic Surveys of Enterobacter aerogenes in Belgian Hospitals from 1996 to 1998

et al. 2001

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Two national surveys were conducted to describe the incidence and prevalence of Enterobacter aerogenes in 21 Belgian hospitals in 1996 and 1997 and to characterize the genotypic diversity and the antimicrobial resistance profiles of clinical strains of E. aerogenes isolated from hospitalized patients in Belgium in 1997 and 1998. Twenty-nine hospitals collected 10 isolates of E. aerogenes, which were typed by arbitrarily primed PCR (AP-PCR) using two primers and pulsed-field gel electrophoresis. MICs of 10 antimicrobial agents were determined by the agar dilution method. Beta-lactamases were detected by the double-disk diffusion test and characterized by isoelectric point. The median incidence of E. aerogenes colonization or infection increased from 3.3 per 1,000 admissions in 1996 to 4.2 per 1000 admissions in the first half of 1997 (P < 0.01). E. aerogenes strains (n ‫؍‬ 260) clustered in 25 AP-PCR types. Two major types, BE1 and BE2, included 36 and 38% of strains and were found in 21 and 25 hospitals, respectively. The BE1 type was indistinguishable from a previously described epidemic strain in France. Half of the strains produced an extended-spectrum betalactamase, either TEM-24 (in 86% of the strains) or TEM-3 (in 14% of the strains). Over 75% of the isolates were resistant to ceftazidime, piperacillin-tazobactam, and ciprofloxacin. Over 90% of the strains were susceptible to cefepime, carbapenems, and aminoglycosides. In conclusion, these data suggest a nationwide dissemination of two epidemic multiresistant E. aerogenes strains in Belgian hospitals. TEM-24 beta-lactamase was frequently harbored by one of these epidemic strains, which appeared to be genotypically related to a TEM-24-producing epidemic strain from France, suggesting international dissemination.

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

Cited by 21 publications

References 26 publications

Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Community and Private Health Care Centers

Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Community and Private Health Care Centers

Coexistence of SHV-4- and TEM-24-Producing Enterobacter aerogenes Strains before a Large Outbreak of TEM-24-Producing Strains in a French Hospital

National Epidemiologic Surveys of Enterobacter aerogenes in Belgian Hospitals from 1996 to 1998

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