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Risk factors for extended-spectrum β-lactamase-producing Enterobacteriaceae carriage in patients admitted to Intensive Care Unit in a Tertiary Care Hospital in Thailand

Kiddee, Anong, Assawatheptawee, Kanit, Na-udom, Anamai, Boonsawang, Pratya, Treebupachatsakul, Pornpit, Walsh, Timothy R. and Niumsup, Pannika R. 2019. Risk factors for extended-spectrum β-lactamase-producing Enterobacteriaceae carriage in patients admitted to Intensive Care Unit in a Tertiary Care Hospital in Thailand. Microbial Drug Resistance 10.1089/mdr.2018.0318

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Abstract

Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) are important causes of serious infections in intensive care unit (ICU). This study aimed to investigate the risk factors for intestinal carriage of ESBL-PE among patients admitted to ICU, subsequent ESBL-PE infections, and outcomes of these patients. This study prospectively collected rectal swabs from 215 ICU patients in Northern Thailand and ESBL-PE were isolated. A high prevalence of ESBL-PE carriage (134/215, 62.3%) at ICU admission was observed, with Escherichia coli representing the predominant organism (67.5%) followed by Klebsiella pneumoniae (19.4%). Multivariate logistic regression analysis identified chronic renal disease as the independent risk factor for ESBL-PE carriage (p = 0.009; adjusted odds ratio = 4.369; 95% confidence interval = 1.455–13.119). Among colonized patients, 2.2% (3/134) developed ESBL-PE infections during ICU stay. Phylogenetic analysis of E. coli (n = 108) showed that the predominant group was group A (38.0%), followed by groups B1 (17.6%), D (15.7%), B2 (14.8%), C (7.4%), and F (6.5%). Multilocus sequence typing analysis of the pathogenic groups B2, D, and F revealed 11 different sequence types (STs), with ST131 (n = 13) as the most prevalent, followed by ST648 (n = 5), ST38 (n = 4), ST393 (n = 3), and ST1193 (n = 3). These results are of concern since ESBL-PE may be a prerequisite for endogenous infections and potentially disseminate within the hospital. This is the first study describing ESBL-PE carriage among patients at ICU admission and subsequent ESBL-PE infections in Thailand.

Item Type: Article
Date Type: Published Online
Status: In Press
Schools: Medicine
Publisher: Mary Ann Liebert
ISSN: 1076-6294
Last Modified: 26 Jul 2019 09:19
URI: http://orca.cf.ac.uk/id/eprint/123468

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