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Intestinal carriage of extended-spectrum beta-lactamase–producing Enterobacteriaceae at admission in a Portuguese hospital

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Abstract

To evaluate the prevalence of extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae fecal carriers at admission in a Portuguese hospital and to determine the epidemiology and antimicrobial resistance patterns of ESBL-producing isolates. During a 2-month period, rectal swabs were collected at hospital admission from 151 at-risk patients. In addition, 48 rectal swabs were obtained from weekly screenings of 37 patients hospitalized for > 48 h. All ESBL/carbapenemase-producing isolates were tested for antimicrobial susceptibility and characterized by PFGE and MLST. The prevalence of ESBL producers at hospital admission was 17% and 24% among at-risk patients hospitalized for > 48 h, while the prevalence of carbapenemase producers was 3% in both cases. Most of the isolates were Escherichia coli (54%) and Klebsiella pneumoniae (41%). The most common ESBL identified was CTX-M-15 (n = 17/34; 50%), followed by CTX-M-27 (n = 10; 29%), CTX-M-33 (n = 4; 12%), SHV-12 (n = 2), and CTX-M-55 (n = 1). The 20 E. coli isolates were distributed into 16 PFGE types and nine sequence types (ST), with 60% of the isolates belonging to ST131. The 15 K. pneumoniae were grouped into 12 PFGE types and nine STs, with three STs (ST17, ST449, ST147) corresponding to 60% of the isolates. A high proportion of isolates showed resistance to ciprofloxacin (86%), trimethoprim-sulfamethoxazole (68%), tobramycin (57%), and gentamicin (43%). All isolates remained susceptible to fosfomycin. A high prevalence of ESBL-producing Enterobacteriaceae was found at hospital admission among at-risk patients and > 50% of the isolates showed resistance to first-line antibiotics for the treatment of lower urinary tract infections, leaving fosfomycin as an alternative.

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Acknowledgments

We are grateful to Dr. Faustino Ferreira (Clinical Director) and Dra. Ana Bela Correia (Pathology Unit Coordinator) from SAMS Hospital, Lisbon, for providing us the local authorizations to perform this study.

Funding

This work was partly supported by project PTDC/DTP-EPI/0842/2014 from Fundação para a Ciência e a Tecnologia (FCT), Portugal, by Project LISBOA-01-0145-FEDER-007660 (Microbiologia Molecular, Estrutural e Celular) funded by FEDER funds through COMPETE2020 - Programa Operacional Competitividade e Internacionalização (POCI), and by national funds through FCT. This work was also partially supported by ONEIDA project (LISBOA-01-0145-FEDER-016417) co-funded by FEEI - “Fundos Europeus Estruturais e de Investimento” from “Programa Operacional Regional Lisboa 2020” and by national funds from FCT, as well as by the University of Fribourg, by the Swiss National Science Foundation (projects FNS-31003A_163432 and FNS-407240_177381). Elizeth Lopes was supported by grant 03/BI/2017 from FCT, Portugal.

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Authors and Affiliations

  1. Escola Superior de Saúde da Cruz Vermelha Portuguesa (ESSCVP), Avenida de Ceuta, No 1, Edifício UrbiCeuta, 1300-906, Lisbon, Portugal

    Marta Aires-de-Sousa

  2. Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica António Xavier (ITQB), Universidade Nova de Lisboa (UNL), Oeiras, Portugal

    Marta Aires-de-Sousa, Elizeth Lopes & Hermínia de Lencastre

  3. Laboratory of Microbiology, Hospital SAMS, Lisbon, Portugal

    Maria Luísa Gonçalves & Ana Luísa Pereira

  4. Department of Medicine, Hospital SAMS, Lisbon, Portugal

    Augusto Machado e Costa

  5. Laboratory of Microbiology and Infectious Diseases, The Rockefeller University, New York, USA

    Hermínia de Lencastre

  6. Medical and Molecular Microbiology Unit, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland

    Laurent Poirel

  7. INSERM European Unit (IAME, France), University of Fribourg, Fribourg, Switzerland

    Laurent Poirel

  8. Swiss National Reference Center for Emerging Antibiotic Resistance (NARA), Fribourg, Switzerland

    Laurent Poirel

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  1. Marta Aires-de-Sousa
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  2. Elizeth Lopes
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  3. Maria Luísa Gonçalves
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  4. Ana Luísa Pereira
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  5. Augusto Machado e Costa
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  6. Hermínia de Lencastre
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  7. Laurent Poirel
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Correspondence to Marta Aires-de-Sousa.

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Aires-de-Sousa, M., Lopes, E., Gonçalves, M.L. et al. Intestinal carriage of extended-spectrum beta-lactamase–producing Enterobacteriaceae at admission in a Portuguese hospital. Eur J Clin Microbiol Infect Dis 39, 783–790 (2020). https://doi.org/10.1007/s10096-019-03798-3

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  • DOI: https://doi.org/10.1007/s10096-019-03798-3

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