240. Prevalence and Molecular Characterization of Fecal Carriage of Extended-Spectrum ?-Lactamases (ESBLs) and Carbapenemases Producing Enterobacteriaceae in Adults with Suspected Community Onset (CO) Urinary Tract Infection (UTI)
Session: Poster Abstract Session: Diagnostic Microbiology; Antimicrobial Sensitivities
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Fecal Carriage of ESBL_IDWeek 2013.pdf (3.0 MB)
  • Background: Intestinal carriers of ESBLs and carbapenemases play an important role in dissemination of bacterial resistance worldwide. The increasing reporting of ESBL-producing bacteria in CO infections highlights the importance of recognizing and characterizing the colonization burden of patients.

    Methods: An analytical cross-sectional study was carried out during a 4-month period in 3 tertiary-care institutions in Colombia. Patients admitted to the emergency room with clinical suspicion of CO-UTI were included. After signing the informed consent, patients had a rectal swab taken and a case report form filled out. Antimicrobial susceptibility and ESBLs screening were tested using Broth Microdilution (BM) method (Sensititre panels; TREK Diagnostic Systems, Westlake, OH); the results were interpreted according to CLSI 2012 guidelines. Modified Hodge Test (MHT) was used for carbapenemases screening.  PCR for blaKPC, blaSHV, blaTEM, blaCTX-M, blaVIM, blaIMP, blaOXA-48, and blaNDM was performed in positive isolates, followed by sequencing. Clonal relatedness was done by automated rep-PCR (DiversiLab; bioMerieux) between the colonizing (5) and the infecting (5) strains.

    Results: From 54 Enterobacteriaceae obtained, 39% (21) were ESBL-positive isolates corresponding to: E. coli (16), K. pneumoniae (4) and S. marcescens (1). ESBL-positive isolates were 100% non-susceptible to ceftriaxone and cefotaxime, 86% to ceftazidime, 81% to ciprofloxacin, 71% to trimethoprim-sulfamethoxazole, 62% to cefepime, and 10 % to amikacin. The predominant ESBL was CTX-M-15 followed by SHV-12 enzymes. MHT was positive in 3/54 isolates but only one encoded a KPC-2 enzyme. Two clones, 1 E. coli and 1 S. marcescens, were colonizing and infecting one different patient each. Of note, the E.coli clone harbored CTXM-15 and belonged to ST131. Intestinal colonization by ESBL-producing Enterobacteriaceae was not statistically associated with a Healthcare-Associated Infection (OR 1.24, CI 95% 0.31 – 4.67) neither with antibiotic treatment 3 months prior admission (OR 1.14, CI 95% 0.35 – 3.69).

    Conclusion: The high proportion of ESBL-producing Enterobacteriaceae among fecal carriers is an important finding, especially due to the presence of the CTXM-15 enzyme belonging to the ST131 in the setting of CO-UTI.

    Victor M Blanco, MD1, Marcela N Perenguez, BSc1, Adriana Correa, MSc1, Juan J Maya, MD1, Gabriel Motoa, MD1, John Quinn, MD2 and Maria V. Villegas, MD, MSc1, (1)Centro Internacional De Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia, (2)AstraZeneca, Waltham, MA

    Disclosures:

    V. M. Blanco, None

    M. N. Perenguez, None

    A. Correa, None

    J. J. Maya, None

    G. Motoa, None

    J. Quinn, AstraZeneca: Employee, Salary

    M. V. Villegas, MSD: Consultant, Research support
    AstraZeneca: Consultant, Research support
    Pfizer: Consultant, Research support
    Merck SA Colombia: Consultant, Research support
    Novartis: Consultant, Research support

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