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Journal of Clinical Microbiology logoLink to Journal of Clinical Microbiology
. 1997 Oct;35(10):2602–2605. doi: 10.1128/jcm.35.10.2602-2605.1997

Molecular epidemiology of acquisition of ceftazidime-resistant gram-negative bacilli in a nonoutbreak setting.

E D'Agata 1, L Venkataraman 1, P DeGirolami 1, M Samore 1
PMCID: PMC230018  PMID: 9316915

Abstract

We prospectively studied the acquisition of ceftazidime-resistant gram-negative bacilli (CAZ-RGN) in two surgical intensive care units (SICU) during a nonoutbreak period. Surveillance cultures were obtained from patients at the time of admission and serially thereafter. CAZ-RGN isolates were typed by pulsed-field gel electrophoresis (PFGE). Three hundred and forty-three patients were enrolled from whom 1,621 baseline and follow-up cultures were obtained. The most common species isolated from patients were Pseudomonas aeruginosa (22), Enterobacter cloacae (21), Acinetobacter spp. (13), Enterobacter aerogenes (11), Citrobacter spp. (10), Pseudomonas spp. (non P. aeruginosa) (9), and Stenotrophomonas spp. (7). For each species, PFGE strain types were highly diverse; no single type was recovered from more than four patients. Twenty-eight patients acquired a CAZ-RGN during the SICU stay; in six (21%), emergence of resistance from a previously susceptible strain was documented on the basis of matching serial strain types. Transmission of CAZ-RGN between patients occurred but was infrequent, as judged by analyzing strain types of epidemiologically linked patients. In conclusion, colonization with CAZ-RGN in SICU was associated with diverse species and strains, as determined by molecular typing. Emergence of resistance from previously susceptible strains appeared to be more important than horizontal transmission in acquisition of CAZ-RGN in a nonoutbreak period.

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Selected References

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  1. Burwen D. R., Banerjee S. N., Gaynes R. P. Ceftazidime resistance among selected nosocomial gram-negative bacilli in the United States. National Nosocomial Infections Surveillance System. J Infect Dis. 1994 Dec;170(6):1622–1625. doi: 10.1093/infdis/170.6.1622. [DOI] [PubMed] [Google Scholar]
  2. Chetchotisakd P., Phelps C. L., Hartstein A. I. Assessment of bacterial cross-transmission as a cause of infections in patients in intensive care units. Clin Infect Dis. 1994 Jun;18(6):929–937. doi: 10.1093/clinids/18.6.929. [DOI] [PubMed] [Google Scholar]
  3. Haertl R., Bandlow G. Epidemiological fingerprinting of Enterobacter cloacae by small-fragment restriction endonuclease analysis and pulsed-field gel electrophoresis of genomic restriction fragments. J Clin Microbiol. 1993 Jan;31(1):128–133. doi: 10.1128/jcm.31.1.128-133.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Hartstein A. I., Rashad A. L., Liebler J. M., Actis L. A., Freeman J., Rourke J. W., Jr, Stibolt T. B., Tolmasky M. E., Ellis G. R., Crosa J. H. Multiple intensive care unit outbreak of Acinetobacter calcoaceticus subspecies anitratus respiratory infection and colonization associated with contaminated, reusable ventilator circuits and resuscitation bags. Am J Med. 1988 Nov;85(5):624–631. doi: 10.1016/s0002-9343(88)80233-x. [DOI] [PubMed] [Google Scholar]
  5. Holmberg S. D., Solomon S. L., Blake P. A. Health and economic impacts of antimicrobial resistance. Rev Infect Dis. 1987 Nov-Dec;9(6):1065–1078. doi: 10.1093/clinids/9.6.1065. [DOI] [PubMed] [Google Scholar]
  6. Jacobson K. L., Cohen S. H., Inciardi J. F., King J. H., Lippert W. E., Iglesias T., VanCouwenberghe C. J. The relationship between antecedent antibiotic use and resistance to extended-spectrum cephalosporins in group I beta-lactamase-producing organisms. Clin Infect Dis. 1995 Nov;21(5):1107–1113. doi: 10.1093/clinids/21.5.1107. [DOI] [PubMed] [Google Scholar]
  7. Marcos M. A., Jimenez de Anta M. T., Vila J. Correlation of six methods for typing nosocomial isolates of Acinetobacter baumannii. J Med Microbiol. 1995 May;42(5):328–335. doi: 10.1099/00222615-42-5-328. [DOI] [PubMed] [Google Scholar]
  8. Minami S., Yotsuji A., Inoue M., Mitsuhashi S. Induction of beta-lactamase by various beta-lactam antibiotics in Enterobacter cloacae. Antimicrob Agents Chemother. 1980 Sep;18(3):382–385. doi: 10.1128/aac.18.3.382. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Sanders C. C., Sanders W. E., Jr Clinical importance of inducible beta-lactamases in gram-negative bacteria. Eur J Clin Microbiol. 1987 Aug;6(4):435–438. doi: 10.1007/BF02013106. [DOI] [PubMed] [Google Scholar]
  10. VanCouwenbergh C., Cohen S. Analysis of epidemic and endemic isolates of Xanthomonas maltophilia by contour-clamped homogeneous electric field gel electrophoresis. Infect Control Hosp Epidemiol. 1994 Nov;15(11):691–696. doi: 10.1086/646839. [DOI] [PubMed] [Google Scholar]
  11. Verweij P. E., Van Belkum A., Melchers W. J., Voss A., Hoogkamp-Korstanje J. A., Meis J. F. Interrepeat fingerprinting of third-generation cephalosporin-resistant Enterobacter cloacae isolated during an outbreak in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 1995 Jan;16(1):25–29. doi: 10.1086/646998. [DOI] [PubMed] [Google Scholar]

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