Brote de Enterobacter cloacae complex multirresistente productor de CTX-M-9 en una unidad de cuidados intensivos / Outbreak of multidrug-resistant CTX-M-9-producing Enterobacter cloacae complex in an intensive care unit

INTRODUCCIÓN: Descripción clínica y epidemiológica de un brote en una unidad de cuidados intensivos (UCI) causado por Enterobacter cloacae complex multirresistente productor de una beta-lactamasa de espectro extendido (BLEE) tipo CTX-M-9. MÉTODOS: Se realizó un estudio retrospectivo de las características clínicas y epidemiológicas del brote causado por E. cloacae complex. La identificación y estudio de sensibilidad de las cepas fueron realizados mediante el sistema semiautomático BD Phoenix™, y la caracterización de la BLEE, por PCR y secuenciación. La tipificación molecular se realizó mediante electroforesis en gel de campo pulsado (PFGE). RESULTADOS: Durante febrero de 2014, 6 pacientes (50% mujeres; media de edad: 61,5 años; rango de edad: 44-76 años) ingresados en la UCI del Complejo Hospitalario de Pontevedra (CHOP) presentaron aislamientos de E. cloacae complex resistente a cefalosporinas de amplio espectro. Tres pacientes desarrollaron infección; uno presentó bacteriemia primaria y shock séptico, y 2 neumonía asociada a ventilación mecánica. En los 3 casos restantes los aislamientos de E. cloacae complex se consideraron colonización. El análisis fenotípico y genotípico reveló que todos los aislados presentaban el mismo perfil por PFGE y que portaban la misma BLEE del tipo CTX-M-9. El brote se controló mediante la mejora de las medidas universales y el aislamiento de contacto de los pacientes infectados y/o colonizados. CONCLUSIÓN: Se describe desde un punto de vista clínico y epidemiológico un brote de E. cloacae complex portador de CTX-M-9 en una UCI

INTRODUCTION: Clinical and epidemiological description of an outbreak in an intensive care unit (ICU) caused by a strain of multidrug-resistant Enterobacter cloacae complex carrying a CTX-M-9-type extended-spectrum beta-lactamase (ESBL). METHODS: A retrospective study of the clinical and epidemiological features of the outbreak caused by E. cloacaecomplex was performed. Identifying and studying the sensitivity of the strains were performed using the semi-automated system BD Phoenix™, and the characterisation of ESBL using PCR and sequencing. Molecular typing was performed by pulsed-field gel electrophoresis (PFGE). RESULTS: During February 2014, 6 patients (50% women; mean age: 61.5 years; age range: 44-76 years) admitted to the ICU of the Hospital of Pontevedra (CHOP) presented resistant E. cloacae complex isolates to extended-spectrum cephalosporins. Three patients developed infection; one had primary bacteraemia and septic shock, and 2 with ventilator-associated pneumonia. In the remaining three cases E. cloacae complex isolates were considered as colonisation. Phenotypic and genotypic analysis revealed that all isolates had the same PFGE profile and carried the same CTX-M-9 ESBL. The outbreak was controlled by improving universal precautions and contact isolation of patients infected and/or colonized. CONCLUSION: The clinical and epidemiological features of an outbreak in an ICU caused by E. cloacae complex carrying CTX-M-9 are described

[Outbreak of multidrug-resistant CTX-M-9-producing Enterobacter cloacae complex in an intensive care unit]. / Brote de Enterobacter cloacae complex multirresistente productor de CTX-M-9 en una unidad de cuidados intensivos.

INTRODUCTION: Clinical and epidemiological description of an outbreak in an intensive care unit (ICU) caused by a strain of multidrug-resistant Enterobacter cloacae complex carrying a CTX-M-9-type extended-spectrum ß-lactamase (ESBL). METHODS: A retrospective study of the clinical and epidemiological features of the outbreak caused by E.cloacae complex was performed. Identifying and studying the sensitivity of the strains were performed using the semi-automated system BD Phoenix™, and the characterisation of ESBL using PCR and sequencing. Molecular typing was performed by pulsed-field gel electrophoresis (PFGE). RESULTS: During February 2014, 6 patients (50% women; mean age: 61.5 years; age range: 44-76 years) admitted to the ICU of the Hospital of Pontevedra (CHOP) presented resistant E.cloacae complex isolates to extended-spectrum cephalosporins. Three patients developed infection; one had primary bacteraemia and septic shock, and 2 with ventilator-associated pneumonia. In the remaining three cases E.cloacae complex isolates were considered as colonisation. Phenotypic and genotypic analysis revealed that all isolates had the same PFGE profile and carried the same CTX-M-9 ESBL. The outbreak was controlled by improving universal precautions and contact isolation of patients infected and/or colonized. CONCLUSION: The clinical and epidemiological features of an outbreak in an ICU caused by E.cloacae complex carrying CTX-M-9 are described.

Listeriosis invasiva en la provincia de Pontevedra: ¿objetivo de vigilancia epidemiológica? / Invasive listeriosis in Pontevedra province, Spain: Target of epidemiological surveillance?

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