Prevalence and Risk Factors for Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae Colonization in Intensive Care Units

Abstract

Active surveillance culture (ASC) can help detect hidden reservoirs, but the routine use of ASC for extended spectrum β-lactamase-producing Enterobacteriaceae is controversial in an endemic situation. We aimed to determine the prevalence and risk factors of extended spectrum β-lactamase-producing Klebsiella pneumoniae (EBSL-Kpn) colonization among intensive care unit (ICU)-admitted patients. Prospective screening of ESBL-Kpn colonization was performed for ICU-admitted patients within 48 hours for two months. A perirectal swab sample was inoculated on MacConkey agar supplemented with 2 μg/mL ceftazidime. ESBL genotype was determined by PCR-sequencing, and clonal relatedness was evaluated by pulsed-field gel electrophoresis (PFGE). The risk factors of ESBL-Kpn colonization were evaluated. The ESBL-Kpn colonization rate among the 281 patients at ICU admission was 6.4% (18/281), and blaCTX-M-15 was detected in all isolates. ESBL producers also showed resistance to fluoroquinolone (38.9%, 7/18). All isolates had the same ESBL genotype (blaCTX-M-15) and a highly clustered PFGE pattern, suggesting cross-transmission without a documented outbreak. In univariate analysis, the risk factor for ESBL-Kpn colonization over the control was the length of hospital stay (odds ratio = 1.062; P = 0.019). Routine use of ASC could help control endemic ESBL-Kpn for ICU patients.

Association between tocilizumab and emerging multidrug-resistant organisms in critically ill patients with COVID-19: A multicenter, retrospective cohort study

“…-PaƟents who were admiƩed to ICU with confirmed COVID- 19 the last 3 months, and systemic corticosteroid use during ICU and ICU LOS. To reduce the risk of bias in the regression model, we used the causal directed acyclic graph approach to ensure the inclusion of several confounders in the regression model that have been associated with an increased risk of developing MDR strains [20][21][22][23]. For other outcomes (MV, ICU, and hospital LOS), multivariable generalized linear regression was used to assess the relationship between tocilizumab use and the different outcomes considered in this study after adjusting for the patients' age, SOFA score, PaO 2 /FiO 2 ratio baseline, and systemic corticosteroids during ICU.…”

Etiología y perfil de susceptibilidad antimicrobiana en sepsis neonatal

“…(16,17) Los microorganismos aislados con mayor frecuencia en sepsis neonatal asociados a cuidados de la salud son especies de Staphylococcus o enterobacterias, para estas bacterias, el medio hospitalario es un ambiente que favorece la adquisición y transmisión de genes de resistencia debido a la presión selectiva que ejercen los antibióticos. (17,18) Los mecanismos de resistencia como la producción de betalactamasas de espectro extendido (BLEE) en especies de Klebsiella o la resistencia a meticilina en Staphylococcus spp., pueden causar fracasos terapéuticos. (18,19) La bacteria más frecuentemente, relacionada a sepsis en el presente estudio, fue S. epidermidis, lo que coincide con lo reportado, en otras investigaciones, donde se informa a este microorganismo como principal patógeno, sobre todo en las unidades neonatales de cuidados intensivos, debido a su alta resistencia a meticilina (>85 %).…”

“…(17,18) Los mecanismos de resistencia como la producción de betalactamasas de espectro extendido (BLEE) en especies de Klebsiella o la resistencia a meticilina en Staphylococcus spp., pueden causar fracasos terapéuticos. (18,19) La bacteria más frecuentemente, relacionada a sepsis en el presente estudio, fue S. epidermidis, lo que coincide con lo reportado, en otras investigaciones, donde se informa a este microorganismo como principal patógeno, sobre todo en las unidades neonatales de cuidados intensivos, debido a su alta resistencia a meticilina (>85 %). (17,19) REE Volumen 16(1) Riobamba ene.…”