Young Ah Kim; Yoon Soo Park; Hyunsoo Kim; Young Hee Seo; Kyungwon Lee

doi:10.5145/ACM.2018.21.2.28

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Kim, Park, Kim, Seo, and Lee: The Usefulness of Active Surveillance Culture of Extended-Spectrum β-Lactamase-Producing Escherichia coli in ICU Settings without Outbreak in the Situation of Wide Spread of Sequence Type 131 ESBL-Producing E. coli in Community

Original Article

Ann Clin Microbiol 2018;21(2):28-35.

Published online: 12 June 2018

DOI: https://doi.org/10.5145/ACM.2018.21.2.28

The Usefulness of Active Surveillance Culture of Extended-Spectrum β-Lactamase-Producing Escherichia coli in ICU Settings without Outbreak in the Situation of Wide Spread of Sequence Type 131 ESBL-Producing E. coli in Community

Young Ah Kim¹, Yoon Soo Park², Hyunsoo Kim³, Young Hee Seo⁴, Kyungwon Lee^4,⁵

^¹Departments of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang

^²Departments of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang

^³Department of Laboratory Medicine, National Police Hospital, Seoul, Korea

^⁴Department of Research Institute of Bacterial Resistance, Seoul, Korea

^⁵Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea

Correspondence: Yoon Soo Park, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang 10444, Korea. (Tel) 82-31-900-0979, (Fax) 82-31-900-0343, (E-mail) yspark@nhimc.or.kr

Received 27 November 2017 Revised 21 March 2018 Accepted 22 March 218

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

In the present study, the prevalence and risk factors for acquisition of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli in intensive care unit (ICU) settings without outbreak in the situation of widespread sequence type (ST) 131 ESBL-producing E. coli in a Korean community was investigated.

Methods

Consecutive and prospective screening of ESBL-producing E. coli colonization was performed in all patients admitted to surgical or medical ICUs within 48 hours for two months. ESBL genotype was determined based on PCR and sequencing. PCR for O16-ST131/O25-ST131 was performed for all ESBL producers. Clinical information was obtained from a review of electronic medical record to determine the risk factors for ESBL-producing E. coli colonization.

Results

The colonization rate of ESBL-producing E. coli at ICU admission was 14.9% (42/281). CTX-M-15 (N=15), CTX-M-14 (N=12), and CTX-M-27 (N=10) were commonly detected using PCR of ESBL genes. Approximately half (45.2%, 19/42) of ESBL producers were ST131 clone with 14 ST131-O25 and 5 ST131-O16. In univariate analysis, independent risk factor for acquisition of ESBL-producing E. coli compared with controls was ICU type (odds ratio, 2.05; P＜ 0.032); however, site of acquisition, previous antibiotic use, and hospital stay were not significant risk factors.

Conclusion

In this study, the colonization of ESBL-producing E. coli at ICU admission without outbreak was frequent and it could be an infection source, regardless of acquisition site. We recommend routine use of ASC to control endemic ESBL-producing E. coli considering the wide distribution of ST131-ESBL-producing E. coli in the Korean community.

Keywords: Escherichia coli, Extended-spectrum lactamase, Prevalence, Sequence type 131

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Fig. 1.

(A) Pulsed-field gel electrophoresis. SM, Lambda Ladders (Preomega, Wisconsin). (B) Dendrogram of XbaI-restricted DNA of colonizing ESBL-producing E. coli isolated from ICU-admitted patients (N=38).* *Five ESBL-producing E. coli isolates were excluded due to repeated failure of re-culture. Abbreviations: ST131, sequence type131; O25, serogroup O25; O16, serogroup O16; ESBL, extended-spectrum beta-lactamase.

Table 1.

Risk factors of ESBL-producing Escherichia coli colonization at ICU admission: Univariate Analysis

Clinical features	ASC for ESBL-producing E. coli		OR (95% CI)	P value
Clinical features	Positive (N=43)*	Negative (N=238)	OR (95% CI)	P value
Age (years)	69.9±14.6	69.4±14.3		0.717
Male sex	20/43	122/238	0.83 (0.43–1.59)	0.567
Hospital stay (day)	4.9±9.0	4.9±8.6		0.955
Site of acquisition
Community-associated	16.3% (7)	17.6% (42)	0.91 (0.35–2.07)	0.828
COHA	46.5% (20)	37.4% (89)	1.46 (0.75–2.80)	0.261
Healthcare-onset	37.2% (16)	45.0% (107)	0.73 (0.36–1.40)	0.347
Previous antibiotics use
3 ^rd generation cephalosporin	16.3% (7)	10.1% (24)	1.73 (0.65–4.14)	0.237
Fluoroquinolone	18.6% (8)	15.5% (37)	1.24 (0.50–2.78)	0.615
Any antibiotics	51.1% (22)	54.6% (130)	0.87 (0.45–1.67)	0.675
ICU type
Medical ICU	58.1% (25)	40.3% (96)	2.05 (1.07–4.02)	0.032
Surgical ICU	41.9% (18)	49.7% (142)	0.49 (0.25–0.94)	0.032

Data are no. (%) of patients. *One E. coli isolate was identified as an ESBL producer by automated system but negative for both repeated PCRs of ESBL genes and double disk synergy test. Abbreviations: ESBL, extended-spectrum-β-lactamase; ICU, Intensive care unit; ASC, active surveillance culture; OR, odds ratio; CI, confidence interval; COHA, community-onset healthcare-associated.

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