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Increasing Prevalence of Gastrointestinal Colonization With Ceftazidime-Resistant Gram-Negative Bacteria Among Intensive Care Unit Patients

Published online by Cambridge University Press:  02 January 2015

Kerri A. Thom*
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland
Judith A. Johnson
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland Veterans Affairs Maryland Health Care System, Baltimore, Maryland
Sandra M. Strauss
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland
Jon P. Furuno
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland
Eli N. Perencevich
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland Veterans Affairs Maryland Health Care System, Baltimore, Maryland
Anthony D. Harris
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland Veterans Affairs Maryland Health Care System, Baltimore, Maryland
*
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 100 North Greene St., Lower Level, Baltimore, Maryland 21201 (kthoms@medicine.umaryland.edu)

Abstract

Background.

The occurrence of nosocomial infections due to third-generation cephalosporin–resistant gram-negative bacteria is increasing. Gastrointestinal colonization is an important reservoir for antibiotic-resistant bacteria, and it often precedes clinical infection.

Objective.

To estimate the prevalence of gastrointestinal colonization with ceftazidime-resistant gram-negative bacteria among intensive care unit (ICU) patients at a university-affiliated tertiary-care hospital during 2 distinct periods and to assess whether, at any time during the index hospitalization, colonized patients had a clinical culture positive for the same organism that was recovered from surveillance culture.

Setting.

Two ICUs at the University of Maryland Medical Center, a 656-bed tertiary-care hospital located in Baltimore, Maryland. Both ICUs provide care to adult patients.

Methods.

We performed a cross-sectional study of adult patients admitted to the medical ICU or the surgical ICU from June 14 to July 14, 2003, and from June 14 to July 14, 2006. Perirectal swab samples were obtained for surveillance culture on admission to the intensive care unit, weekly thereafter, and at discharge. Each culture sample was plated onto MacConkey agar supplemented with ceftazidime.

Results.

In 2003, a total of 33 (18.8%) of 176 patients were colonized with ceftazidime-resistant gram-negative bacilli; in 2006, 60 (31.4%) of 191 patients were (P<.01). This increase was largely driven by an increase in ceftazidime-resistant Klebsiella isolates (which accounted for 6.4% of isolates in 2003 and for 22.8% in 2006; P<.01). In 2003, a total of 16 (48.5%) of 33 colonized patients had a clinical culture positive for the same organism that was recovered from the perirectal surveillance culture, compared with 22 (36.6%) of 60 colonized patients in 2006 (P = .28).

Conclusion.

Our data suggest that gastrointestinal colonization with ceftazidime-resistant gram-negative bacilli is common, that its prevalence is increasing, and that colonization may result in clinical cultures positive for these bacilli.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L, the Healthcare Infection Control Practices Advisory Committee. Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006. Atlanta, GA: Centers for Disease Control and Prevention;2006.Google Scholar
2.National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470485.Google Scholar
3.Jones, RN, Varnam, DJ. Antimicrobial activity of broad-spectrum agents tested against gram-negative bacilli resistant to ceftazidime: report from the SENTRY Antimicrobial Surveillance Program (North America, 2001). Diagn Microbiol Infect Dis 2002;44:379382.CrossRefGoogle ScholarPubMed
4.Flournoy, DJ, Reinert, RL, Bell-Dixon, C, Gentry, CA. Increasing antimicrobial resistance in gram-negative bacilli isolated from patients in intensive care units. Am J Infect Control 2000;28:244250.CrossRefGoogle ScholarPubMed
5.Lautenbach, E, Patel, JB, Bilker, WB, Edelstein, PH, Fishman, NO. Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outcomes. Clin Infect Dis 2001;32:11621171.CrossRefGoogle ScholarPubMed
6.Tumbarello, M, Spanu, T, Sanguinetti, M, et al. Bloodstream infections caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae: risk factors, molecular epidemiology, and clinical outcome. Antimicrob Agents Chemother 2006;50:498504.CrossRefGoogle ScholarPubMed
7.Kang, CI, Kim, SH, Park, WB, et al. Bloodstream infections due to extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for mortality and treatment outcome, with special emphasis on antimicrobial therapy. Antimicrob Agents Chemother 2004;48:45744581.CrossRefGoogle ScholarPubMed
8.Donskey, CJ. Antibiotic regimens and intestinal colonization with antibiotic-resistant gram-negative bacilli. Clin Infect Dis 2006;43(suppl 2):S62S69.Google Scholar
9.Schimpff, SC, Young, VM, Greene, WH, Vermeulen, GD, Moody, MR, Wiernik, PH. Origin of infection in acute nonlymphocytic leukemia: significance of hospital acquisition of potential pathogens. Ann Intern Med 1972;77:707714.Google Scholar
10.Seiden, R, Lee, S, Wang, WL, Bennett, JV, Eickhoff, TC. Nosocomial Klebsiella infections: intestinal colonization as a reservoir. Ann Intern Med 1971;74:657664.Google Scholar
11.Wingard, JR, Dick, J, Charache, P, Saral, R. Antibiotic-resistant bacteria in surveillance stool cultures of patients with prolonged neutropenia. Antimicrob Agents Chemother 1986;30:435439.Google Scholar
12.Salyers, AA, Gupta, A, Wang, Y. Human intestinal bacteria as reservoirs for antibiotic resistance genes. Trends Microbiol 2004;12:412416.Google Scholar
13.Harris, AD, McGregor, JC, Furuno, JP. What infection control interventions should be undertaken to control multidrug-resistant gram-negative bacteria? Clin Infect Dis 2006;43(suppl 2):S5761.Google Scholar
14.Clinical Laboratory Standards Institute (CLIS). Performance Standards for Antimicrobial Susceptibility Testing: 16th Informational Supplement. Wayne, PA: CLIS;2006:M100S16.Google Scholar
15.Harris, Ad, Smith, D, Johnson, JA, Bradham, DD, Roghmann, MC. Risk factors for imipenem-resistant Pseudomonas aeruginosa among hospitalized patients. Clin Infect Dis 2002;34:340345.CrossRefGoogle ScholarPubMed
16.Furuno, JP, Perencevich, EN, Johnson, JA, et al. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci co-colonization. Emerg Infect Dis 2005;11:15391544.CrossRefGoogle ScholarPubMed
17.D'Agata, EM, Venkataraman, L, DeGirolami, P, et al. Colonization with broad-spectrum cephalosporin-resistant gram-negative bacilli in intensive care units during a nonoutbreak period: prevalence, risk factors, and rate of infection. Crit Care Med 1999;27:10901095.CrossRefGoogle ScholarPubMed
18.Gardam, MA, Burrows, LL, Kus, JV, et al. Is surveillance for multidrug-resistant Enterobacteriaceae an effective infection control strategy in the absence of an outbreak? J Infect Dis 2002;186:17541760.Google Scholar
19.Cosgrove, SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis 2006;42(suppl 2):S8289.Google Scholar
20.Hollander, R, Ebke, M, Barck, H, von Pritzbuer, E. Asymptomatic carriage of Klebsiella pneumoniae producing extended-spectrum β-lactamase by patients in a neurological early rehabilitation unit: management of an outbreak. J Hosp Infect 2001;48:207213.CrossRefGoogle Scholar
21.Meyer, KS, Urban, C, Eagan, JA, Berger, BJ, Rahal, JJ. Nosocomial outbreak of Klebsiella infection resistant to late-generation cephalosporins. Ann Intern Med 1993;119:353358.CrossRefGoogle ScholarPubMed
22.Asensio, A, Oliver, A, Gonzalez-Diego, P, et al. Outbreak of a multiresistant Klebsiella pneumoniae strain in an intensive care unit: antibiotic use as risk factor for colonization and infection. Clin Infect Dis 2000;30:5560.CrossRefGoogle Scholar
23.Pena, C, Pujol, M, Ardanuy, C, et al. Epidemiology and successful control of a large outbreak due to Klebsiella pneumoniae producing extended-spectrum β-lactamases. Antimicrob Agents Chemother 1998;42:5358.CrossRefGoogle ScholarPubMed
24.Blot, S, Depuydt, P, Vogelaers, D, et al. Colonization status and appropriate antibiotic therapy for nosocomial bacteremia caused by antibiotic-resistant gram-negative bacteria in an intensive care unit. Infect Control Hosp Epidemiol 2005;26:575579.CrossRefGoogle Scholar
25.Kreger, BE, Craven, DE, McCabe, WR. Gram-negative bacteremia. IV. Re-evaluation of clinical features and treatment in 612 patients. Am J Med 1980;68:344355.CrossRefGoogle ScholarPubMed
26.Bryan, CS, Reynolds, KL, Brenner, ER. Analysis of 1,186 episodes of gram-negative bacteremia in non-university hospitals: the effects of antimicrobial therapy. Rev Infect Dis 1983;5:629638.Google Scholar
27.Ibrahim, EH, Sherman, G, Ward, S, Fraser, VJ, Kollef, MH. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 2000;118:146155.Google Scholar
28.MacArthur, RD, Miller, M, Albertson, T, et al. Adequacy of early empiric antibiotic treatment and survival in severe sepsis: experience from the MONARCS trial. Clin Infect Dis 2004;38:284288.CrossRefGoogle ScholarPubMed
29.Kang, CI, Kim, SH, Park, WB, et al. Bloodstream infections caused by antibiotic-resistant gram-negative bacilli: risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome. Antimicrob Agents Chemother 2005;49:760766.CrossRefGoogle Scholar
30.Barza, M, Giuliano, M, Jacobus, NV, Gorbach, SL. Effect of broad-spectrum parenteral antibiotics on “colonization resistance” of intestinal microflora of humans. Antimicrob Agents Chemother 1987;31:723727.CrossRefGoogle ScholarPubMed
31.Saurina, G, Quale, JM, Manikal, VM, Oydna, E, Landman, D. Antimicrobial resistance in Enterobacteriaceae in Brooklyn, NY: epidemiology and relation to antibiotic usage patterns. J Antimicrob Chemother 2000;45:895898.CrossRefGoogle ScholarPubMed
32.Vignoli, R, Calvelo, E, Cordeiro, NF, et al. Association of broad-spectrum antibiotic use with faecal carriage of oxyimino-cephalosporin-resistant Enterobacteriaceae in an intensive care unit.J Hosp Infect 2006;63:306315.CrossRefGoogle Scholar
33.D'Agata, E, Venkataraman, L, DeGirolami, P, Samore, M. Molecular epidemiology of acquisition of ceftazidime-resistant gram-negative bacilli in a nonoutbreak setting. J Clin Microbiol 1997;35:26022605.CrossRefGoogle Scholar
34.Grundmann, H, Barwolff, S, Tami, A, et al. How many infections are caused by patient-to-patient transmission in intensive care units? Crit Care Med 2005;33:946951.Google Scholar
35.Eisen, D, Russell, EG, Tymms, M, Roper, EJ, Grayson, ML, Turnidge, J. Random amplified polymorphic DNA and plasmid analyses used in investigation of an outbreak of multiresistant Klebsiella pneumoniae. J Clin Microbiol 1995;33:713717.CrossRefGoogle ScholarPubMed
36.Lucet, JC, Decre, D, Fichelle, A, et al. Control of a prolonged outbreak of extended-spectrum β-lactamase-producing Enterobacteriaceae in a university hospital. Clin Infect Dis 1999;29:14111418.CrossRefGoogle ScholarPubMed
37.Troche, G, Joly, LM, Guibert, M, Zazzo, JF. Detection and treatment of antibiotic-resistant bacterial carriage in a surgical intensive care unit: a 6-year prospective survey. Infect Control Hosp Epidemiol 2005;26:161165.Google Scholar
38.Thouverez, M, Talon, D, Bertrand, X. Control of Enterobacteriaceae producing extended-spectrum β-lactamase in intensive care units: rectal screening may not be needed in non-epidemic situations. Infect Control Hosp Epidemiol 2004;25:838841.Google Scholar
39.Lautenbach, E, Harris, AD, Perencevich, EN, Nachamkin, I, Tolomeo, P, Metlay, JP. Test characteristics of perirectal and rectal swab compared to stool sample for detection of fluoroquinolone-resistant Escherichia coli in the gastrointestinal tract. Antimicrob Agents Chemother 2005;49:798800.CrossRefGoogle ScholarPubMed