ISSN: 0034-8376
eISSN: 2564-8896
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Abstract

Intestinal Colonization by Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae in Infants

VOLUME 67 - NUMBER 5 / September - October (Original Article)

Gloria Concepción Huerta-García, Department of Infectious Diseases, Hospital de Pediatría, Centro Medico Nacional Siglo XXI, IMSS, México D.F, México
Guadalupe Miranda-Novales, Medical Research Unit in Hospital Epidemiology, Coordinación de Investigación en Salud, IMSS, México D.F, México
Rita Díaz-Ramos, Coordinación de Unidades Medicas de Alta Especialidad, IMSS, México D.F, México
Guillermo Vázquez-Rosales, Department of Infectious Diseases, Hospital de Pediatría, Centro Medico Nacional Siglo XXI, IMSS, México D.F, México
Fortino Solórzano-Santos, Department of Infectious Diseases, Hospital de Pediatría, Centro Medico Nacional Siglo XXI, IMSS, México D.F, México

Background: Members of the Enterobacteriaceae family are common agents of nosocomial infections. Intestinal colonization by these microorganisms represents a major step in the development of systemic infection. Extended-spectrum b-lactamase-producing bacteria are usually associated with outbreaks, but endemic infections are common in intensive care units. Objective: To determine the frequency of intestinal colonization with extended-spectrum b-lactamase-producing Enterobacteriaceae in newborns. Patients and Methods: This was a descriptive cohort study. Newborns from two general hospitals (A and B) in Mexico City were included during a five-month period; those with a hospital stay > 7 days were selected. Fecal samples were obtained by rectal swab on day 7 and every week until discharge. Extended-spectrum b-lactamase production was confirmed in enterobacteria by the Etest. Clonal relatedness was established by pulsed-field gel electrophoresis. Results: 102 newborns were included; 63/102 (61.7%) were colonized by extended-spectrum b-lactamase-producing Enterobacteriaceae on day 7, 17/21 (81%) on day 14, and 6/8 (75%) on day 21 of hospitalization. Klebsiella pneumoniae was recovered most frequently (75.4%). A predominant clone (95%) was found in hospital B, and a major clone (75%) in Hospital A. Other extended-spectrum b-lactamase-producing Enterobacteriaceae isolates were Enterobacter spp. (16%) and Escherichia coli (7.6%). Conclusions: High rates of colonization and horizontal transmission of extended-spectrum b-lactamase-producing Enterobacteriaceae were found in the newborn care units of two general hospitals. Clonal relatedness was identified. Lack of adherence to standard precautions and hand hygiene were determining factors.

Keywords: Enterobacteria. Beta-lactamases. Colonization. Newborn. Klebsiella spp.

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