The prevalence and molecular epidemiology of multidrug-resistant enterobacteriaceae colonization in a pediatric intensive care unit

Nuntra Suwantarat, Latania K. Logan, Karen C Carroll, Robert A. Bonomo, Patricia Simner, Susan D. Rudin, Aaron Milstone, Tsigereda Tekle, Tracy Ross, Pranita Tamma

Research output: Contribution to journalArticle

Abstract

objective. To determine the prevalence and acquisition of extended-spectrumβ-lactamases (ESBLs), plasmid-mediatedAmpCs (pAmpCs), and carbapenemases (MDR Enterobacteriaceae) colonizing children admitted to a pediatric intensive care unit (PICU). design. Prospective study. setting. 40-bed PICU. methods. Admission and weekly thereafter rectal surveillance swabs were collected on all pediatric patients during a 6-month study period. Routine phenotypic identification and antibiotic susceptibility testing were performed. Enterobacteriaceae displaying characteristic resistance profiles underwent further molecular characterization to identify genetic determinants of resistance likely to be transmitted on mobile genetic elements and to evaluate relatedness of strains including DNA microarray, multilocus sequence typing, repetitive sequence-based PCR, and hsp60 sequencing typing. results. Evaluating 854 swabs from unique children, the overall prevalence of colonization with anMDR Enterobacteriaceae upon admission to the PICU based on β-lactamase gene identification was 4.3% (n=37), including 2.8% ESBLs (n=24), 1.3% pAmpCs (n=11), and 0.2% carbapenemases (n=2). Among 157 pediatric patients contributing 603 subsequent weekly swabs, 6 children (3.8%) acquired an incident MDR Enterobacteriaceae during their PICU stay. One child acquired a pAmpC (E. coli containing blaDHA) related to an isolate from another patient. conclusions. Approximately 4% of children admitted to a PICU were colonized with MDR Enterobacteriaceae (based on β-lactamase gene identification) and an additional 4% of children who remained in the PICU for at least 1 week acquired 1 of these organisms during their PICU stay. The acquired MDR Enterobacteriaceae were relatively heterogeneous, suggesting that a single source was not responsible for the introduction of these resistance mechanisms into the PICU setting.

Original languageEnglish (US)
Pages (from-to)535-543
Number of pages9
JournalInfection Control and Hospital Epidemiology
Volume37
Issue number5
DOIs
StatePublished - May 1 2016

ASJC Scopus subject areas

  • Microbiology (medical)
  • Epidemiology
  • Infectious Diseases

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