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Prevalence and Risk Factors for Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae Colonization in Intensive Care Units

Annals of Laboratory Medicine 2020년 40권 2호 p.164 ~ 168
 ( Kim Young-Ah ) - National Health Insurance Service Ilsan Hospital Department of Laboratory Medicine

 ( Park Yoon-Soo ) - National Health Insurance Service Ilsan Hospital Department of Internal Medicine
 ( Kim Ban-Seok ) - National Health Insurance Service Ilsan Hospital Department of Laboratory Medicine
 ( Seo Young-Hee ) - Yonsei University College of Medicine Research Institute of Bacterial Resistance
 ( Lee Kyung-Won ) - Yonsei University College of Medicine Department of Laboratory Medicine

Abstract


Active surveillance culture (ASC) can help detect hidden reservoirs, but the routine use of ASC for extended spectrum β-lactamase-producing Enterobacteriaceae is controversial in an endemic situation. We aimed to determine the prevalence and risk factors of extended spectrum β-lactamase-producing Klebsiella pneumoniae (EBSL-Kpn) colonization among intensive care unit (ICU)-admitted patients. Prospective screening of ESBL-Kpn colonization was performed for ICU-admitted patients within 48 hours for two months. A perirectal swab sample was inoculated on MacConkey agar supplemented with 2 μg/mL ceftazidime. ESBL genotype was determined by PCR-sequencing, and clonal relatedness was evaluated by pulsed-field gel electrophoresis (PFGE). The risk factors of ESBL-Kpn colonization were evaluated. The ESBL-Kpn colonization rate among the 281 patients at ICU admission was 6.4% (18/281), and blaCTX-M-15 was detected in all isolates. ESBL producers also showed resistance to fluoroquinolone (38.9%, 7/18). All isolates had the same ESBL genotype (blaCTX-M-15) and a highly clustered PFGE pattern, suggesting cross-transmission without a documented outbreak. In univariate analysis, the risk factor for ESBL-Kpn colonization over the control was the length of hospital stay (odds ratio=1.062; P=0.019). Routine use of ASC could help control endemic ESBL?Kpn for ICU patients.

키워드

Colonization; Extended spectrum β-lactamase; Klebsiella pneumoniae; Prevalence; Risk factor
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