Assessment of extended-spectrum β-lactamases and integrons among Enterobacteriaceae in device-associated infections: multicenter study in north of Iran.

Gohar Eslami,Fatemeh Ahangarkani,Azin Hajalibeig,Attieh Nikkhah,Alireza Rafiei,Mohammad Sadegh Rezai,Masoumeh Bagheri-Nesami

doi:10.1186/s13756-016-0143-2

Abstract

BackgroundDevice-associated nosocomial infections (DA-NIs), due to MDR Enterobacteriaceae, are a major threat to patient safety in ICUs. We investigated on Extended-spectrum β-lactamases (ESBL) producing Enterobacteriaceae and incidence of integrons in these bacteria isolated from ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTIs) in 18 governmental hospitals in the north of Iran.MethodsIn this cross-section study, the antibiotic susceptibility test was performed using the MIC method; also, phenotypically detection of ESBL-producing bacteria was carried out by the double-disk synergy (DDS) test. Presence of ESBL-related genes and integron Classes 1 and 2 was evaluated by the PCR method.ResultsOut of a total of 205 patients with DA-NIs, Enterobacteriaceae were responsible for (72.68%) of infections. The most common DA-NIs caused by Enterobacteriaceae were VAP (77.18%), CAUTI (19.46%), and sepsis due to VAP (3.35%). The most frequently Enterobacteriaceae were; Klebsiella pneumoniae 75 (24; 32% ESBL positive), E. coli 69 (6; 8.69% ESBL positive) and Enterobacter spp. 5 (5; 100% ESBL positive). Distribution of ESBL-related genes was as follows: bla-SHV (94.3%), bla-CTX (48.6%), bla-VEB (22.9%) and bla-GES (17.14%). The incidence rate of integron class 1 and class 2 was (82.92%) and (2.9%) respectively. Eight types of ESBL-producing bacteria were observed.ConclusionsDue to the fact that the emergence rate of ESBL Enterobacteriaceae is increasing in DA-NIs, co-incidence of different types of ESBL genes with integrons in 75–100% of strains in our study is alarming for clinicians and healthcare safety managers. Therefore, regional and local molecular level estimations of ESBLs that are agents of DA-NIs are critical for better management of empiric therapy, especially for patients in ICUs.Electronic supplementary materialThe online version of this article (doi:10.1186/s13756-016-0143-2) contains supplementary material, which is available to authorized users.

Highlights

Device-associated nosocomial infections (DA-Nosocomial infection (NIs)), due to multiple drug resistant (MDR) Enterobacteriaceae, are a major threat to patient safety in Intensive care unit (ICU)
Due to the fact that the emergence rate of extended-spectrum beta-lactamase (ESBL) Enterobacteriaceae is increasing in Device-associated nosocomial infections (DA-NIs), co-incidence of different types of ESBL genes with integrons in 75–100% of strains in our study is alarming for clinicians and healthcare safety managers
Regional and local molecular level estimations of ESBLs that are agents of DA-NIs are critical for better management of empiric therapy, especially for patients in ICUs

Summary

Introduction

Device-associated nosocomial infections (DA-NIs), due to MDR Enterobacteriaceae, are a major threat to patient safety in ICUs. We investigated on Extended-spectrum β-lactamases (ESBL) producing Enterobacteriaceae and incidence of integrons in these bacteria isolated from ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTIs) in 18 governmental hospitals in the north of Iran. Device-associated nosocomial infections (DA-NIs), especially ventilator-associated pneumonia (VAP) and catheterassociated urinary tract infections (CAUTIs) pose the greatest threat to patient safety in the ICUs [1,2,3]. Resistance to broad-spectrum cephalosporin is spreading quickly among Enterobacteriaceae and this is mostly related to acquisition of ESBL genes. Isolates that express ESBL phenotypes and hydrolize the beta lactam antibiotics are often multiple drug resistant (MDR). The commonly genes related to the ESBL phenotype

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