Risk factors for extended-spectrum β-lactamase-producing Serratia marcescens and Klebsiella pneumoniae acquisition in a neonatal intensive care unit
Risk factors for extended-spectrum β-lactamase-producing Serratia marcescens and Klebsiella pneumoniae acquisition in a neonatal intensive care unit
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DOI：
10.1016/j.jhin.2007.07.026
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发表时间：
2007-10-01
影响因子：
6.9
通讯作者：
Zarrilli, R.
中科院分区：
文献类型：
--
作者：
Crivaro, V.;Bagattini, M.;Zarrilli, R.
我们在意大利一所大学医院的新生儿重症监护室（NICU）中调查了庆大霉素耐药、产超广谱β-内酰胺酶（ESBL）的肺炎克雷伯菌和粘质沙雷菌的分子流行病学，以及与其获得相关的危险因素。在研究期间（2004年4 - 11月），S. marcescens感染6株，定植31株，K.肺炎是6例感染和103例定植的原因。在24名新生儿中同时分离出两种微生物。分子分型确定了一个主要的脉冲场得到电泳模式，每一个S。marcescens和K.在研究期间分离的肺炎菌株。从两株S. marcescens和K. pneumoniae菌株，并显示相同的限制性图谱，将对第三代头孢菌素的耐药性转移到以前敏感的大肠杆菌宿主。胎儿体重、胎龄和有创性器械的使用与S。marcescens和K.单因素分析显示，感染肺炎是唯一的独立危险因素，而氨苄西林和庆大霉素的经验性抗菌治疗以及住院时间被证明是唯一的独立危险因素。总之，接合质粒转移和氨苄青霉素和庆大霉素的经验性抗菌治疗可能有助于选择和传播的庆大霉素耐药产ESBL肠杆菌科在新生儿重症监护病房。(C)2007年，医院感染协会。由爱思唯尔有限公司出版。保留所有权利。
We investigated the molecular epidemiology of gentamicin-resistant, extended -spectrum beta-lactamase (ESBL) -producing Klebsiella pneumoniae and Serratia marcescens, and risk factors associated with their acquisition in a neonatal intensive care unit (NICU) of a university hospital in Italy. During the study period (April-November 2004), S. marcescens was responsible for six infections and 31 colonisations, while K. pneumoniae was responsible for six infections and 103 colonisations. Concurrent isolation of both organisms occurred in 24 neonates. Molecular typing identified one major pulsed-field get electrophoresis pattern each for S. marcescens and K. pneumoniae strains isolated during the study period. An 80 kb plasmid containing bla(SHV-12), bla(TEM-1) and aac(6')-lb genes, isolated from both S. marcescens and K. pneumoniae strains, and showing identical restriction profiles, transferred resistance to third-generation cephalosporins to a previously susceptible Escherichia coli host. Birthweight, gestational age and use of invasive devices were significantly associated with S. marcescens and K. pneumoniae acquisition on univariate analysis, while empiric antimicrobial treatment with ampicillin and gentamicin, and duration of hospital stay, proved to be the only independent risk factors. In conclusion, conjugal plasmid transfer and empiric antimicrobial therapy with ampicillin and gentamicin might have contributed to the selection and spread of gentamicin-resistant ESBL-producing Enterobacteriaceae in the NICU. (C) 2007 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.