Emergence of third‐generation cephalosporin‐resistant Enterobacteriacae in a Japanese critical care setting. Issue 4 (10th July 2014)

• Record Type: Journal Article
• Authors: Hagiya, Hideharu; Murase, Tomoko; Suzuki, Masato; Otsuka, Fumio; Shibayama, Keigo
• Is Part Of: Acute medicine & surgery. Volume 1:Issue 4(2014)
• Page Start: 256
• Page End: 258
• Publication Date: 2014-07-10
• Subjects: Surgery -- Periodicals; Medical emergencies -- Periodicals; 617.005
• DOI: 10.1002/ams2.64
• Languages: English
• ISSNs: 2052-8817

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ams264-sec-0001" sec-type="section"> <title>Aim</title> <p>Extended‐spectrum beta‐lactamases and AmpC beta‐lactamases give resistance to <italic>E</italic><italic>nterobacteriaceae</italic> against cephalosporins, which are important drugs in various clinical settings. Within 5 days, a total of eight strains of <italic>C</italic><italic>itrobacter freundii</italic> and two strains of <italic>E</italic><italic>scherichia coli</italic>, all of which were resistant to third‐generation cephalosporins, were isolated from six different patients in a critical care center. We carried out epidemiological and genetic studies to confirm the situation to be an outbreak by a single strain or a beta‐lactamase‐producing gene.</p> </sec> <sec id="ams264-sec-0002" sec-type="section"> <title>Methods</title> <p>A review of patients' clinical data, pulsed‐field gel electrophoresis epidemiological study against the strains, and polymerase chain reaction analysis for the detection of extended‐spectrum beta‐lactamase genes (<italic>TEM</italic>, <italic>SHV</italic>, <italic>CTX</italic><italic>‐</italic><italic>M</italic><italic>‐1</italic>, <italic>CTX</italic><italic>‐</italic><italic>M</italic><italic>‐2</italic>, and <italic>CTX</italic><italic>‐</italic><italic>M</italic><italic>‐9</italic>) and multiplex polymerase chain reaction analysis for plasmid‐mediated AmpC‐beta‐lactamase genes were carried out.</p> </sec> <sec id="ams264-sec-0003" sec-type="section"> <title>Results</title> <p>Pulsed‐field gel electrophoresis showed none of the subjects were genetically identical organisms. However, all strains possessed either extended‐spectrum beta‐lactamases (<italic>TEM</italic>, <italic>CTX</italic><italic>‐</italic><italic>M</italic><italic>‐2</italic>, and <italic>CTX</italic><italic>‐</italic><italic>M</italic><italic>‐9</italic>) or AmpC‐beta‐lactamases. One patient carried both extended‐spectrum beta‐lactamase‐ and AmpC‐ beta‐lactamase‐producing organisms.</p> </sec> <sec id="ams264-sec-0004" sec-type="section"> <title>Conclusion</title> <p>This study revealed that various types of easily transmittable drug resistance genes exist in the critical care setting concurrently. This case was not an outbreak of such strains, but the present situation might indicate a more serious condition than a mere outbreak of a single resistant strain. <italic>E</italic><italic>nterobacteriaceae</italic> that possess extended‐spectrum beta‐lactamases or AmpC‐beta‐lactamases are increasingly common in many medical institutions in Japan, and constitutive monitoring of drug‐resistant organisms and proper contact precautions are essential to prevent possible outbreaks.</p> </sec> </abstract>