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The Prevalence and Molecular Epidemiology of Multidrug-Resistant Enterobacteriaceae Colonization in a Pediatric Intensive Care Unit

Published online by Cambridge University Press:  09 February 2016

Nuntra Suwantarat ,
Latania K. Logan ,
Karen C. Carroll ,
Robert A. Bonomo ,
Patricia J. Simner ,
Susan D. Rudin ,
Aaron M. Milstone ,
Tsigereda Tekle ,
Tracy Ross  and
Pranita D. Tamma
Nuntra Suwantarat
Affiliation:
Division of Medical Microbiology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
Latania K. Logan
Affiliation:
Section of Pediatric Infectious Diseases, Rush University Medical Center, Chicago, Illinois, USA Louis Stokes Cleveland Department of Veterans’ Affairs Medical Center, Cleveland, Ohio, USA
Karen C. Carroll
Affiliation:
Division of Medical Microbiology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
Robert A. Bonomo
Affiliation:
Louis Stokes Cleveland Department of Veterans’ Affairs Medical Center, Cleveland, Ohio, USA Geriatrics Research, Education and Clinical Center, Louis Stokes Cleveland Department of Veterans’ Affairs Medical Center, Cleveland, Ohio, USA Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
Patricia J. Simner
Affiliation:
Division of Medical Microbiology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
Susan D. Rudin
Affiliation:
Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
Aaron M. Milstone
Affiliation:
Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Tsigereda Tekle
Affiliation:
Division of Medical Microbiology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
Tracy Ross
Affiliation:
Division of Medical Microbiology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
Pranita D. Tamma*
Affiliation:
Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
*
Address correspondence to Pranita D. Tamma, MD, MHS, The Johns Hopkins University School of Medicine, 200 North Wolfe St., Suite 3149, Baltimore, MD 21287 (ptamma1@jhmi.edu).
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Abstract

OBJECTIVE

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).

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 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.

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.

Infect Control Hosp Epidemiol 2016;37:535–543

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 5 , May 2016 , pp. 535 - 543
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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