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

영아 김1   윤수 박*2   현수 김3   영희 서4   경원 이45   

1 Departments of 1Laboratory Medicine
2 Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang
3 Department of Laboratory Medicine, National Police Hospital
4 Research Institute of Bacterial Resistance
5 Department of Laboratory Medicine,Yonsei University College of Medicine

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 ESBLproducing 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-ESBLproducing E. coli in the Korean community. (Ann Clin Microbiol 2018;21:28-35)

Keywords

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


Acknowledgements

본 연구는 대한임상미생물학회 연구비 지원으로 수행되었음 (2017-01).

Figures & Tables

Fig. 1. (A) Pulsed-field gel electrophoresis. SM, Lambda Ladders (Preomega, Wisconsin). (B) Dendrogram of XbaI-restricted DNA of colonizing ESBL-producing E. coli isolated from ICU-admitted patients (N=38).* *Five ESBL-producing E. coli isolates were excluded due to repeated failure of re-culture. Abbreviations: ST131, sequence type131; O25, serogroup O25; O16, serogroup O16; ESBL, extended-spectrum beta-lactamase.


Figures & Tables

Table 1. Risk factors of ESBL-producing Escherichia coli colonization at ICU admission: Univariate Analysis

Clinical featuresASC for ESBL-producing E. coliOR (95% CI)P value
Positive (N=43)*Negative (N=238)
Age (years)69.9±14.669.4±14.30.717
Male sex20/43122/2380.83 (0.43-1.59)0.567
Hospital stay (day)4.9±9.0 4.9±8.6 0.955
Site of acquisition
Community-associated16.3% (7)17.6% (42)0.91 (0.35-2.07)0.828
COHA46.5% (20)37.4% (89)1.46 (0.75-2.80)0.261
Healthcare-onset37.2% (16)45.0% (107)0.73 (0.36-1.40)0.347
Previous antibiotics use
3 generation cephalosporin16.3% (7)10.1% (24)1.73 (0.65-4.14)0.237
Fluoroquinolone18.6% (8)15.5% (37)1.24 (0.50-2.78)0.615
Any antibiotics51.1% (22)54.6% (130)0.87 (0.45-1.67)0.675
ICU type
58.1% (25)40.3% (96) (1.07-4.02)
Surgical ICU41.9% (18)49.7% (142)0.49 (0.25-0.94)0.032