Prevalence, risk factors and molecular epidemiology of highly resistant gram negative rods in hospitalized patients in the Dutch region Kennemerland

Abstract

BackgroundThis paper describes (1) the Highly Resistant Gram Negative Rod (HR-GNR) prevalence rate, (2) their genotypes, acquired resistance genes and (3) associated risk factors of HR-GNR colonization among the hospitalized population in the Dutch region Kennemerland.MethodsBetween 1 October 2013 and 31 March 2014, cross-sectional prevalence measurements were performed in three regional hospitals as part of each hospitals infection control program. Rectal swabs were analyzed at the Regional Public Health Laboratory Kennemerland by direct culturing. Genotypes and acquired resistance genes of positive isolates were determined using Whole Genome Sequencing with the MiSeq instrument (Illumina). Association between several independent variables and HR-GNR positivity was examined using logistic regression models.ResultsOut of 427 patients, 24 HR-GNR positive isolates were recovered from 22 patients, resulting in a regional HR-GNR colonization prevalence (95 % CI) of 5.2 % (3.6–7.9). Of these 22 positive patients, 15 were Extended Spectrum Beta-Lactamase (ESBL) positive (3.5 % (2.1–5.7)), 7 patients were positive for a Fluoroquinolones and Aminoglycosides (Q&A) resistant Enterobacteriaceae (1.6 % (0.8–3.3)) and from one patient (0.2 % (0–1.3)) a Stenotrophomonas maltophilia resistant towards co-trimoxazole was isolated. No carbapenemase producing Enterobacteriaceae (CPE), multi-resistant Acinetobacter species or multi-resistant Pseudomonas aeruginosa were isolated. The ESBL genes found were blaCTX-M-1 (n = 4, 25.0 %), blaCTX-M-15 (n = 3, 18.8 %), blaCTX-M-27 (n = 2, 12.5 %), blaCTX-M-14b (n = 2, 12.5 %), blaCTX-M-9 (n = 2, 12.5 %), blaCTX-M-14 (n = 1, 6.3 %), blaCTX-M-3 (n = 1, 6.3 %), blaSHV-11 (n = 1, 6.3 %) and blaSHV-12 (n = 1, 6.3 %). Being known HR-GNR positive in the past was the only significant associated risk factor for HR-GNR positivity, odds ratio (95 % CI): 7.32 (1.82–29.35), p-value = 0.005.ConclusionsSimilar ESBL prevalence rates and genotypes (3.5 %) were found in comparison to other Dutch studies. When previously HR-GNR positive patients are readmitted, they should be screened for HR-GNR colonization since colonization with GR-GNRs could be prolonged. We recommend for future studies to include all defined HR-GNRs in addition to ESBLs in prevalence studies, in order to obtain a more comprehensive overview of colonization with HR-GNRs.

No nosocomial transmission under standard hygiene precautions in short term contact patients in case of an unexpected ESBL or Q&A E. coli positive patient: a one-year prospective cohort study within three regional hospitals

“…Around these 35 index patients, 69 contact patients were sampled, accounting for a total of 178 contact days. Although no nosocomial transmission had occurred, five contact patients were HR-GNR positive (7.2%) and four of these were ESBL E. coli positive (5.8%), which corresponds with earlier reported prevalence rates in Dutch hospitals [6, 27]. As expected, ESBL positive patients were found most frequently among all HR-GNR positive patients (68.6%) and index patients (68.6%).…”

Study of pervasiveness, antimicrobial vulnerability and resolution of best method for determining extended spectrum beta lactamases Escherichia coli isolates

“…ESBL producer E. coli produces pink or purple colour colonies. 24 Double disc synergy test (DDST): Prepare a lawn culture by isolated bacteria on the surface of MHA. DDST was performed by placing a disk of amoxiclav/clavulanic acid (20/10µg), third generation cephalosporin (30µg) and aztreonam (30µg) were placed accordance to CLSI guidelines for anti microbial susceptibility test.…”

Complete Genome Sequence of Escherichia coli ABWA45, an rmtB -Encoding Wastewater Isolate

“…Of note, E. coli isolates belonging to ST635 have been associated with the production of either New Delhi metallo-β-lactamases or extended-spectrum β-lactamases (11, 12). These findings suggest that ST635 might play an important role in the spread of many different important resistance determinants.…”