Annals of Clinical Microbiology, The official Journal of the Korean Society of Clinical Microbiology

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pISSN 2288-0585 eISSN 2288-6850

The Usefulness of Active Surveillance Culture of Extended-Spectrum β-Lactamase-Producing Escherichia coli in ICU Settings without Outbreak in the Situation of Wide Spread of Sequence Type 131 ESBL-Producing E. coli in Community

Original article

Annals of Clinical Microbiology (Ann Clin Microbiol) 2018 June, Volume 21, Issue 2, pages 28-35.

https://doi.org/10.5145/ACM.2018.21.2.28

The Usefulness of Active Surveillance Culture of Extended-Spectrum β-Lactamase-Producing Escherichia coli in ICU Settings without Outbreak in the Situation of Wide Spread of Sequence Type 131 ESBL-Producing E. coli in Community

Young Ah Kim1, Yoon Soo Park2, Hyunsoo Kim3, Young Hee Seo4, Kyungwon Lee4,5
Departments of 1Laboratory Medicine, 2Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, 3Department of Laboratory Medicine, National Police Hospital, 4Research Institute of Bacterial Resistance and 5Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea

Abstract

Background: In the present study, the prevalence and risk factors for acquisition of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli in intensive care unit (ICU) settings without outbreak in the situation of widespread sequence type (ST) 131 ESBL-producing E. coli in a Korean community was investigated.

Methods: Consecutive and prospective screening of ESBL-producing E. coli colonization was performed in all patients admitted to surgical or medical ICUs within 48 hours for two months. ESBL genotype was determined based on PCR and sequencing. PCR for O16-ST131/O25-ST131 was performed for all ESBL producers. Clinical information was obtained from a review of electronic medical record to determine the risk factors for ESBL-producing E. coli colonization.

Results: The colonization rate of ESBL-producing E. coli at ICU admission was 14.9% (42/281). CTX-M-15 (N=15), CTX-M-14 (N=12), and CTX-M-27 (N=10) were commonly detected using PCR of ESBL genes. Approximately half (45.2%, 19/42) of ESBL producers were ST131 clone with 14 ST131-O25 and 5 ST131- O16. In univariate analysis, independent risk factor for acquisition of ESBL-producing E. coli compared with controls was ICU type (odds ratio, 2.05; P< 0.032); however, site of acquisition, previous antibiotic use, and hospital stay were not significant risk factors.

Conclusion: In this study, the colonization of ESBL- producing E. coli at ICU admission without outbreak was frequent and it could be an infection source, regardless of acquisition site. We recommend routine use of ASC to control endemic ESBL-producing E. coli considering the wide distribution of ST131-ESBL- producing E. coli in the Korean community. (Ann Clin Microbiol 2018;21:28-35)

Keywords

Escherichia coli, Extended-spectrum β– lactamase, Prevalence, Sequence type 131