The Prevalence and Molecular Epidemiology of Multidrug-Resistant Enterobacteriaceae Colonization in a Pediatric Intensive Care Unit.
The Prevalence and Molecular Epidemiology of Multidrug-Resistant Enterobacteriaceae Colonization in a Pediatric Intensive Care Unit.
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DOI：
10.1017/ice.2016.16
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发表时间：
2016-05
影响因子：
4.5
通讯作者：
Tamma PD
中科院分区：
文献类型：
--
作者：
Suwantarat N;Logan LK;Carroll KC;Bonomo RA;Simner PJ;Rudin SD;Milstone AM;Tekle T;Ross T;Tamma PD
为了确定延伸谱β-内酰胺酶（ESBLS）的患病率和获取，质粒介导的AMPC（PAMPC）和碳二苯甲酸酯酶（“ MDR肠杆菌科”）在儿童中殖民儿童，该儿童被接受了儿童重症监护室（PICU）。
前瞻性研究。
40床Picu。
在6个月的研究期间，对所有儿科患者收集了直肠监测拭子，并在常规的表型鉴定期间收集。 ilocus序列键入，基于重复序列的PCR和HSP60测序键入。
评估来自独特儿童的85个拭子，基于β-内酰胺酶基因鉴定的PICU时，与MDR肠杆菌科的总体流行率为4.3％（n = 37），包括2.8％ESBLS（N = 24）（n = 24），1.3％PAMPC（n = 11）和0.2％carbapenem sep sectial（n = 2％）。 ABS，有6名儿童（3.8％）获得了事件MDR肠杆菌科中的PICU住宿。
大约有4％的PICU儿童用MDR肠杆菌科（基于β-内酰胺酶基因鉴定）和额外的4％的儿童在PICU中至少获得了1周的1周，从而在其PICU中获得了这些生物，在他们的PICU持续情况下，该机制是相对范围的。 PICU设置。
To determine the prevalence and acquisition of extended-spectrum β-lactamases (ESBLs), plasmid-mediated AmpCs (pAmpCs), and carbapenemases (“MDR Enterobacteriaceae”) colonizing children admitted to a pediatric intensive care unit (PICU). Prospective study. 40-bed PICU. 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. Evaluating 854 swabs from unique children, the overall prevalence of colonization with an MDR 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. 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.