Risk Factors for Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Carriage in Patients Admitted to Intensive Care Unit in a Tertiary Care Hospital in Thailand

Kiddee, Anong; Assawatheptawee, Kanit; Na-udom, Anamai; Boonsawang, Pratya; Treebupachatsakul, Pornpit; Walsh, Timothy R.; Niumsup, Pannika R.

doi:10.1089/mdr.2018.0318

Cited by 25 publications

(14 citation statements)

References 39 publications

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“…5,8 Colonization with ESBL-PE frequently precedes invasive diseases. 9,10 Fecal carriage of ESBL-PE could pose greater risk in people living with HIV due to the increased risk of severe bacterial infections. 1,2 In Tanzania, studies have documented high frequency of infections caused by ESBL-PE in hospitalized patients.…”

Section: Introductionmentioning

confidence: 99%

High Prevalence of Fecal Carriage of Extended Spectrum β-Lactamase-Producing Enterobacteriaceae Among Newly HIV-Diagnosed Adults in a Community Setting in Tanzania

Manyahi

Moyo

Tellevik

et al. 2020

Microbial Drug Resistance

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Colonization in HIV-infected populations with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) is particularly worrisome in low-income settings. This study describes the prevalence of ESBL-PE carriage and associated risk factors among newly HIV-diagnosed adults in a community setting in Tanzania. A total of 595 newly diagnosed HIV adults with a median age of 35 years with interquartile range (IQR) 29–42 years and a median CD4 count of 492 cells/μL (IQR 390–666 cells/μL) were recruited. Among these, 194/595 (32.6%, 95% confidence interval [CI] 28.9–36.6) were ESBL-PE carriers. Participants with low CD4 count (<350 cells/μL) had significantly higher prevalence of ESBL-PE carriage compared with those with CD4 count ≥350 cells/μL (26/58, 44.8%, vs. 168/537, 31.3%, p = 0.04). Antibiotic use in last 4 weeks (odds ratio [OR] 1.55, 95% CI 1.08–2.22, p = 0.02) and CD4 count ≥350 cells/μL (OR 1.78, 95% CI 1.03–3.09, p = 0.04) were independent risk factors for fecal carriage of ESBL-PE. In total, 244 isolates of ESBL-PE were isolated from 194 participants. Of these, 238/244 (97.5%) harbored bla CTX-M genes, with bla CTX-M-15 being predominant (219/238 (92%), followed by bla CTX-M-27 (9/238 (3.8%), bla CTX-M-14 (8/238 (3.4%), bla CTX-M-55 (1/238), and bla CTX-M 211/3 (1/238). bla SHV-2a genes were detected in four isolates, whereas the bla SHV-12 gene was detected in one isolate. Phenotypic carbapenemase-producing Enterobacteriaceae was detected in one HIV-positive person with CD4 count 132 cells/μL. In conclusion prevalence of ESBL-PE carriage is high among newly diagnosed HIV adults in Dar es Salaam, and is significantly associated antibiotic use and low CD4 count.

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Section: Introductionmentioning

confidence: 99%

High Prevalence of Fecal Carriage of Extended Spectrum β-Lactamase-Producing Enterobacteriaceae Among Newly HIV-Diagnosed Adults in a Community Setting in Tanzania

Manyahi

Moyo

Tellevik

et al. 2020

Microbial Drug Resistance

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“…In human medicine, several studies were conducted on carriage of ESBL-PE on admission to emergency and intensive care units. Shedding rates varied dramatically between reports in different countries from 4 to 62.5% [ 6 , 32 , 33 ] and risk factors for ESBL-PE shedding included elderly age, cirrhosis, broad-spectrum antibiotic treatment, urinary or intra-abdominal infections and residence in overcrowded households districts [ 34 , 35 ]. Hospitalization in the previous year was identified as a risk factor for ESBL-PE shedding in dogs and cats in both periods ( p =0.01, OR = 3.05, 95% CI 1.28–7.27, Table 5 ), as reported before in human medicine [ 20 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

Extended-Spectrum β-Lactamase-Producing Enterobacterales Shedding by Dogs and Cats Hospitalized in an Emergency and Critical Care Department of a Veterinary Teaching Hospital

et al. 2020

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Extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) gut shedding in human medicine is considered as a major reservoir for ESBL-associated infections in high risk patients. In veterinary medicine, data regarding ESBL-PE gut shedding on admission to emergency and critical care department is scarce. We aimed to determine ESBL-PE shedding rates by dogs and cats in this setting and to determine the risk factors for shedding, at two separate periods, three-years apart. Rectal swabs were collected from animals, on admission and 72 h post admission, enriched and plated on Chromagar ESBL plates, followed by bacterial identification. ESBL phenotype was confirmed and antibiotic susceptibility profiles were determined (Vitek 2). Medical records were reviewed for risk factor analysis (SPSS). Overall, 248 animals were sampled, including 108 animals on period I (2015–2016) and 140 animals on period II (2019). In both periods combined, 21.4% of animals shed ESBL-PE on admission, and shedding rates increased significantly during hospitalization (53.7%, p-value < 0.001). The main ESBL-PE species were Escherichia coli and Klebsiella pneumoniae, accounting for more than 85% of the isolates. In a multivariable analysis, previous hospitalization was a risk factor for ESBL-PE gut shedding (p-value = 0.01, Odds ratio = 3.05, 95% Confidence interval 1.28–7.27). Our findings demonstrate significant ESBL-PE gut shedding among small animals in the emergency and critical care department, posing the necessity to design and implement control measures to prevent transmission and optimize antibiotic therapy in this setting.

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“…We analyzed the difference in age and gender between two groups only. But there are lots of factors associated with MDROs status, like invasive operation, having chronic renal disease, APACHE ≥ 15, previous hospital stay ≥ 10 days, emergency surgery, and so on [15] [16].Since these factors can in uence hospital expenses and length of ICU stay, so we got no difference between the two groups. We also think the perfect endpoint of the bene t of precaution is the dissemination rate of MDRO.…”

Section: Discussionmentioning

confidence: 88%

Proposing a new strategy of combining machine learning with controlling cross-transmission of multi-drug resistant organisms of ICU

zou

Kaihong

Kang

et al. 2020

Preprint

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Abstract Background Multi-drug resistant organisms (MDROs) has become a global threat to public health. MDROs are normally transmitted from patients to patients via the hands of healthcare workers (HCWs). The key management of MDROs is control dissemination as sooner as possible. Method: We established a predictive rule based simply on experiences, and according to the result of this predictive rule we take a series of precautions of a general intensive care unit (ICU) from January 1, 2018, to December 31, 2019, only in one ward experimentally. In this study, we aim to assess the efficiency of the routine care practice which include pre-discrimination by the predictive rule and sequent precautions by doing difference comparisons. Results After comparing two wards in the hospital expenses and length of ICU stay, there are no statistical differences. Precautions contribute to the association between room number and status of MDROs infection/ colonization(p = 0.033), and infection/colonization rate of MDROs is different statistically between two wards(p = 0.006). Conclusion the routine care practice had controlled the cross-transmission of MDROs in some extent. Future, studies can engage in updating the predictive model based on big data and referred to experts’ experiences and adopt more efficient precautions for strengthening the transmission efficiency.

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Risk Factors for Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Carriage in Patients Admitted to Intensive Care Unit in a Tertiary Care Hospital in Thailand

Cited by 25 publications

References 39 publications

High Prevalence of Fecal Carriage of Extended Spectrum β-Lactamase-Producing Enterobacteriaceae Among Newly HIV-Diagnosed Adults in a Community Setting in Tanzania

High Prevalence of Fecal Carriage of Extended Spectrum β-Lactamase-Producing Enterobacteriaceae Among Newly HIV-Diagnosed Adults in a Community Setting in Tanzania

Extended-Spectrum β-Lactamase-Producing Enterobacterales Shedding by Dogs and Cats Hospitalized in an Emergency and Critical Care Department of a Veterinary Teaching Hospital

Proposing a new strategy of combining machine learning with controlling cross-transmission of multi-drug resistant organisms of ICU

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