Department of Microbiology, St. Vincent's University Hospital and School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. Electronic address: n.o'
Department of Microbiology, St. Vincent's University Hospital and School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
J Hosp Infect. 2015 Jun;90(2):102-7. doi: 10.1016/j.jhin.2015.01.018. Epub 2015 Feb 21.
Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) are Gram-negative, multi-drug-resistant organisms that are of major clinical significance among immunocompromised patients in high-risk areas in hospital settings. In Ireland, the number of ESBL-E bloodstream infections is increasing.
To conduct a prevalence study of ESBL-E among immunocompromised patients in high-risk areas [intensive care unit (ICU), liver transplantation and haematology/oncology wards], characterize any ESBL genes detected by polymerase chain reaction (PCR), and perform epidemiological typing using pulsed-field gel electrophoresis (PFGE).
In total, 317 non-duplicate rectal swabs from patients in high-risk wards were screened anonymously for ESBL-E carriage. Positive isolates were characterized using PCR to detect blaCTX-M, blaTEM, blaOXA-1 and blaSHV ESBL-E genes. Clonal relationships of these isolates were investigated using PFGE.
Fifty (15.8%) high-risk patients were found to harbour ESBL-E. Prevalence rates of 21.9% (N = 28), 14.3% (N = 15) and 8.3% (N = 7) of ESBL-E were isolated from patients on the liver transplantation, ICU and haematology/oncology wards, respectively. Seventy percent of ESBL-E isolates carried more than one resistance gene. Of the 25 ESBL-producing Escherichia coli isolates typed by PFGE, two pairs of two isolates demonstrated >80% homology, and four of the five ESBL-producing Enterobacter cloacae isolates typed by PFGE demonstrated >80% homology, suggesting clonal relatedness and potential cross-transmission from individual patients.
A significant proportion of the patients screened were found to be colonized with ESBL-E. Typing revealed three incidents of potential cross-infection. Therefore, timely detection of ESBL-E among patients in high-risk wards is critical for treatment and infection control.
产超广谱β-内酰胺酶肠杆菌科（ESBL-E）是革兰氏阴性、多药耐药的生物体，在医院环境中高危地区免疫功能低下的患者中具有重要的临床意义。在爱尔兰，产 ESBL-E 血流感染的数量正在增加。
在高危地区（重症监护病房（ICU）、肝移植和血液科/肿瘤科病房）免疫功能低下的患者中进行 ESBL-E 的患病率研究，通过聚合酶链反应（PCR）对检测到的任何 ESBL 基因进行特征分析，并使用脉冲场凝胶电泳（PFGE）进行流行病学分型。
共对高危病房的 317 例非重复直肠拭子进行匿名筛查，以检测 ESBL-E 携带情况。阳性分离株通过 PCR 检测 blaCTX-M、blaTEM、blaOXA-1 和 blaSHV ESBL-E 基因进行特征分析。使用 PFGE 研究这些分离株的克隆关系。
发现 50 例（15.8%）高危患者携带 ESBL-E。从肝移植、ICU 和血液科/肿瘤科病房的患者中分离出 ESBL-E 的患病率分别为 21.9%（N=28）、14.3%（N=15）和 8.3%（N=7）。70%的 ESBL-E 分离株携带一种以上耐药基因。25 株 PFGE 分型的产 ESBL 大肠埃希菌分离株中有两株对两株显示>80%同源性，5 株 PFGE 分型的产 ESBL 阴沟肠杆菌分离株中有 4 株显示>80%同源性，提示存在克隆相关性和潜在的个体患者间交叉传播。
筛选的患者中有相当大比例被发现定植 ESBL-E。分型显示有三起潜在的交叉感染事件。因此，及时检测高危病房患者中的 ESBL-E 对于治疗和感染控制至关重要。
