Emergence of multidrug-resistant Gram-negative bacteria during selective decontamination of the digestive tract on an intensive care unit

• Published in: Journal of antimicrobial chemotherapy Vol. 58; no. 4; pp. 853 - 856
• Main Authors: Al Naiemi, Nashwan, Heddema, Edou R., Bart, Aldert, de Jonge, Evert, Vandenbroucke-Grauls, Christina M., Savelkoul, Paul H. M., Duim, Birgitta
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.10.2006; Oxford Publishing Limited (England)
• Subjects: Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - pharmacology; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacteria; beta-Lactamases - genetics; Biological and medical sciences; Decontamination - methods; Digestive system; Digestive System - drug effects; Digestive System - microbiology; Drug resistance; Drug Resistance, Multiple, Bacterial; ESBLs; Escherichia coli; Escherichia coli - classification; Escherichia coli - drug effects; Escherichia coli - isolation & purification; Genetics; Gram-Negative Bacteria - drug effects; Gram-Negative Bacteria - enzymology; Gram-Negative Bacteria - isolation & purification; Humans; Intensive care; Intensive Care Units; Klebsiella pneumoniae; Klebsiella pneumoniae - classification; Klebsiella pneumoniae - drug effects; Klebsiella pneumoniae - isolation & purification; Medical sciences; Microbial Sensitivity Tests; Pharmacology. Drug treatments; Plasmids - genetics; Polymerase Chain Reaction; Polymorphism, Restriction Fragment Length; resistance; SDD; Sequence Analysis, DNA; Intensive care; SDD; Decontamination; Multiple resistance; ESBLs; Epidemiology; Digestive tract; Intensive care unit; resistance; Gram negative bacteria
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkl316

Objectives: During treatment with selective decontamination of the digestive tract (SDD), four multidrug-resistant (MDR) strains, three different Escherichia coli and one Klebsiella pneumoniae, were isolated from four patients not known as carriers of such MDR strains before their admission to the intensive care unit (ICU) in the Academic Medical Center (AMC) in Amsterdam. These isolates were extended-spectrum β-lactamase (ESBL)-positive. We investigated whether this was due to interspecies transfer of resistance genes. Methods: The MDR strains were typed by amplified fragment length polymorphism (AFLP) analysis. The plasmids from these strains were characterized by restriction fragment length polymorphism and the resistance genes were characterized by PCR and sequence analysis. Results: The strains were genetically unrelated and contained identical plasmids with ESBL genes. Conclusions: We identified an outbreak of plasmid-mediated ESBL genes during SDD treatment in the ICU. The use of third-generation cephalosporins in SDD is associated with the emergence of ESBLs. We conclude that identification of emerging MDR Gram-negative bacteria and recognition of resistance plasmid transfer during SDD treatment are crucial for optimal application of this regimen in ICUs.