Annals of Laboratory Medicine

Korean Society for Laboratory Medicine (대한진단검사의학회)
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Rates of Fecal Transmission of Extended-Spectrum ${\beta}$-Lactamase-Producing and Carbapenem-Resistant Enterobacteriaceae Among Patients in Intensive Care Units in Korea

  • Kim, Jayoung (Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital) ;
  • Lee, Ji Young (Department of Infection Control, Seoul St. Mary's Hospital) ;
  • Kim, Sang Il (Division of Infectious Disease, Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Song, Wonkeun (Department of Laboratory Medicine, Hallym University College of Medicine) ;
  • Kim, Jae-Seok (Department of Laboratory Medicine, Hallym University College of Medicine) ;
  • Jung, Seungwon (Department of Laboratory Medicine, Hallym University College of Medicine) ;
  • Yu, Jin Kyung (Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital) ;
  • Park, Kang Gyun (Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital) ;
  • Park, Yeon-Joon (Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital)
  • Received : 2013.05.06
  • Accepted : 2013.10.17
  • Published : 2014.01.02
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Abstract

Background: We investigated the rates of fecal transmission of extended-spectrum ${\beta}$-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) and carbapenem-resistant Enterobacteriaceae (CRE) among patients admitted to intensive care units (ICUs). Methods: From June to August 2012, rectal cultures were acquired from all patients at ICU admission. For patients not carrying ESBL-E or CRE at admission, follow-up cultures were performed to detect acquisition. A chromogenic assay was used to screen for ESBL-E and CRE. Bacterial species identification and antibiotic susceptibility tests were performed using the Vitek 2 system (bioM$\acute{e}$rieux, France). ESBL genotypes were determined by PCR, and clonal relatedness of the isolates was assessed by pulsed-field gel electrophoresis. Results: Out of 347 ICU admissions, 98 patients were found to be carriers of ESBL-E (28.2%, 98/347). Follow-up cultures were acquired from 91 of the patients who tested negative for ESBL-E at admission; the acquisition rate in this group was 12.1% (11/91), although none was a nosocomial transmission. For CRE, the prevalence of fecal carriage was 0.3% (1/347), and the acquisition rate was 2.9% (4/140). None of the CRE isolates were carbapenemase-producers. Conclusions: The high prevalence of ESBL-E carriage on admission (28.2%), coupled with rare nosocomial transmission and the very low carriage rate of CRE (0.3%), challenge the routine use of active surveillance in non-epidemic settings. Nevertheless, passive surveillance measures, such as rapid and accurate screening of clinical specimens, will be critical for controlling the spread of CRE.

Keywords

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