RESUMO
OBJECTIVE: The objective of this study is to determine the prevalence of rectal carriage of plasmid- and chromosome-encoded AmpC ß-lactamase-producing Escherichia coli and Klebsiella spp. in patients in a Dutch teaching hospital between 2013 and 2016. METHODS: Between 2013 and 2016, hospital-wide yearly prevalence surveys were performed to determine the prevalence of AmpC ß-lactamase-producing E. coli and Klebsiella spp. rectal carriage. Rectal swabs were taken and cultured using an enrichment broth and selective agar plates. All E. coli and Klebsiella spp. isolates were screened for production of AmpC ß-lactamase using phenotypic confirmation tests and for the presence of plasmid-encoded AmpC (pAmpC) genes. E. coli isolates were screened for chromosome-encoded AmpC (cAmpC) promoter/attenuator alterations. RESULTS: Fifty (2.4%) of 2,126 evaluable patients were identified as rectal carrier of AmpC ß-lactamase-producing E. coli. No carriage of AmpC ß-lactamase producing Klebsiella spp. was found. Nineteen (0.9%) patients harboured isolates with pAmpC genes and 30 (1,4%) patients harboured isolates with cAmpC promoter/attenuator alterations associated with AmpC ß-lactamase overproduction. For one isolate, no pAmpC genes or cAmpC promotor/attenuator alterations could be identified. During the study period, a statistically significant decline in the prevalence of rectal carriage with E. coli with cAmpC promotor/attenuator alterations was found (p = 0.012). The prevalence of pAmpC remained stable over the years. CONCLUSIONS: The prevalence of rectal carriage of AmpC-producing E. coli and Klebsiella spp. in patients in Dutch hospitals is low and a declining trend was observed for E. coli with cAmpC promotor/attenuator alterations.
Assuntos
Proteínas de Bactérias/genética , Infecções por Escherichia coli/epidemiologia , Escherichia coli/crescimento & desenvolvimento , Infecções por Klebsiella/epidemiologia , beta-Lactamases/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise do Polimorfismo de Comprimento de Fragmentos Amplificados , Proteínas de Bactérias/metabolismo , Criança , Pré-Escolar , Escherichia coli/enzimologia , Infecções por Escherichia coli/microbiologia , Feminino , Hospitais de Ensino , Humanos , Lactente , Recém-Nascido , Klebsiella/enzimologia , Klebsiella/crescimento & desenvolvimento , Infecções por Klebsiella/microbiologia , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Fenótipo , Prevalência , Regiões Promotoras Genéticas , Reto/microbiologia , Adulto Jovem , beta-Lactamases/metabolismoRESUMO
This paper describes the trends in prevalence of ESBL producing Enterobacteriaceae (ESBL-E) and ESBL genes, measured in five consecutive yearly Point Prevalence Surveys (PPS). All patients present in the hospital and in a day-care clinic (including patients on dialysis) on the day of the survey, were screened for perianal ESBL-E carriage. Perianal swabs were taken and cultured using an enrichment broth and a selective agar plate. Both phenotypic and genotypic methods were used to detect the production of ESBL, presence of ESBL-genes and clonal relatedness. Out of 2,695 patients, 135 (5.0%) were tested ESBL-E positive. The overall ESBL-E prevalence was stable over the years. Overall 5.2% of all ESBL-E were acquired by nosocomial transmission. A relative decrease of CTX-M-1-1-like ESBL genes (from 44 to 25%, p = 0.026) was observed, possibly related to the strong (>60%) decrease in antibiotic use in livestock in our country during the same period.
