Colonisation and infection due to Enterobacteriaceae producing plasmid-mediated AmpC beta-lactamases
Por:
Rodriguez-Bano, J, Miro, E, Villar, M, Coelho, A, Gozalo, M, Borrell, N, Bou, G, Conejo, MC, Pomar, V, Aracil, B, Larrosa, N, Aguero, J, Oliver, A, Fernandez, A, Oteo, J, Pascual, A, Navarro, F
Publicada:
1 feb 2012
Resumen:
Objectives: To investigate theepidemiology and clinical features of infections caused by Enterobacteria producing plasmid-mediated AmpC beta-lactamases (pAmpC), which are emerging as a cause of resistance to extended-spectrum cephalosporins.
Methods: A prospective multicentre cohort of patients with infection/colonisation due to pAmpC-producing Enterobacteriaceae was performed in 7 Spanish hospitals from February throughout July 2009. pAmpCs were characterised by PCR and sequencing.
Results: 140 patients were included; organisms isolated were Escherichia coli (n=100), Proteus mirabilis (n=20), Klebsiella pneumoniae (n=17), and others (n=3). Overall, 90% had a chronic underlying condition. The acquisition was nosocomial in 43%, healthcare-associated in 41% (14% of those were nursing home residents), and community in 16%. Only 5% of patients had no predisposing feature for infection with multidrug-resistant bacteria. Nineteen percent of patients were bacteraemic. Inappropriate empirical therapy was administered to 81% of bacteraemic patients, who had a crude mortality rate of 48%. The most frequent enzyme was CMY-2 (70%, predominantly in E. coli and P. mirabilis) followed by DHA-1 (19%, predominantly in K. pneumoniae).
Conclusion: pAmpC-producing Enterobacteriaceae caused nosocomial, healthcare-associated and community infections mainly inpredisposed patients. Invasive infections were associated with high mortality which might be partly related to inappropriate empirical therapy. (C) 2011 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
Filiaciones:
Rodriguez-Bano, J:
Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas & Microbiol, Seville 41009, Spain
Univ Seville, Dept Med, E-41009 Seville, Spain
Miro, E:
Univ Autonoma Barcelona, Microbiol Serv, Hosp Santa Creu & St Pau, Barcelona 08025, Spain
Villar, M:
Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas & Microbiol, Seville 41009, Spain
Coelho, A:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Microbiol Serv, Barcelona 08035, Spain
Gozalo, M:
Hosp Univ Marques de Valdecilla IFIMAV, Microbiol Serv, Santander 39008, Spain
Borrell, N:
Hosp Univ Son Espases, Microbiol Serv, Palma De Mallorca 07011, Spain
Bou, G:
Complejo Hosp Univ A Coruna, Microbiol Serv, La Coruna 15006, Spain
Conejo, MC:
Univ Seville, Dept Microbiol, E-41009 Seville, Spain
Pomar, V:
Univ Autonoma Barcelona, Unidad Enfermedades Infecciosas, Hosp Santa Creu & St Pau, Barcelona 08025, Spain
Aracil, B:
Ctr Nacl Microbiol Virol & Inmunol Sanitarias Maja, Lab Antibiot, Madrid 28220, Spain
Larrosa, N:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Microbiol Serv, Barcelona 08035, Spain
Aguero, J:
Hosp Univ Marques de Valdecilla IFIMAV, Microbiol Serv, Santander 39008, Spain
Univ Cantabria, Dept Biol Mol, Santander 39011, Spain
Oliver, A:
Hosp Univ Son Espases, Microbiol Serv, Palma De Mallorca 07011, Spain
Fernandez, A:
Complejo Hosp Univ A Coruna, Microbiol Serv, La Coruna 15006, Spain
Oteo, J:
Ctr Nacl Microbiol Virol & Inmunol Sanitarias Maja, Lab Antibiot, Madrid 28220, Spain
Pascual, A:
Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas & Microbiol, Seville 41009, Spain
Univ Seville, Dept Microbiol, E-41009 Seville, Spain
Navarro, F:
Univ Autonoma Barcelona, Microbiol Serv, Hosp Santa Creu & St Pau, Barcelona 08025, Spain
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