High Frequency of Colonization by Extended-spectrum Beta-lactamase-producing Gram-negative Bacilli in Hemodialysis Patients and Their Household Contacts in Colombia: Dissemination Between the Community and the Hospital

Overview

Journal Epidemiol Health

Specialty Public Health

Date 2022 Sep 13

PMID 36097808

Authors

Daniela Montoya-Urrego

Sara Tellez-Carrasquilla

Johanna M Vanegas

Judy Natalia Jimenez Quiceno

Affiliations

Soon will be listed here.

Abstract

Objectives: Increasing colonization by beta-lactam-resistant Gram-negative bacilli (BR-GNB) represents a risk for infections and bacterial resistance spread, both in hospitals and the community. Hemodialysis patients and their household contacts regularly transit between these environments. This study investigated the clinical and epidemiological characteristics of BR-GNB colonization in hemodialysis patients and their household contacts, as well as the genetic relationship between their isolates.

Methods: A cross-sectional study was conducted on hemodialysis patients at a hospital-associated dialysis center in Medellín, Colombia and their household contacts. Clinical and epidemiological information was collected. Colonization was assessed from stool or rectal swab samples. Bacterial identification and susceptibility were determined using chromogenic media and Vitek-2. Molecular characterization included beta-lactamase detection by polymerase chain reaction, multiple-locus sequence typing (MLST), pulsed-field gel electrophoresis, and identification of Escherichia coli phylogroups by the Clermont protocol.

Results: This study included 36 hemodialysis patients and 90 household contacts. Colonization by BR-GNB occurred in 58.3% of patients and 22.2% of household contacts. The main beta-lactamase detected was CTX-M group-1 (40.5%). In 3 of the 9 homes that had more than 1 colonized individual, a genetic relationship was found. MLST showed a high diversity in E. coli isolates, and the most frequent phylogroups were B1 and B2.

Conclusions: These results show a high frequency of colonization and the presence of potentially pathogenic BR-GBN both in hospitals and the community. This highlights the importance of populations who move between those 2 environments, and the need to prevent the spread of bacterial resistance outside hospitals.

Citing Articles

Clinical outcomes of carbapenem-resistant gram-negative bacterial bloodstream infection in patients with end-stage renal disease in intensive care units: a multicenter retrospective observational study.

Lin Y, Yang K, Peng C, Chan M, Sheu C, Feng J Infection. 2024; 53(1):197-207.

PMID: 38995550 DOI: 10.1007/s15010-024-02343-5.

Molecular and Clinical Data of Antimicrobial Resistance in Microorganisms Producing Bacteremia in a Multicentric Cohort of Patients with Cancer in a Latin American Country.

Cruz-Vargas S, Garcia-Munoz L, Cuervo-Maldonado S, Alvarez-Moreno C, Saavedra-Trujillo C, Alvarez-Rodriguez J Microorganisms. 2023; 11(2).

PMID: 36838324 PMC: 9960769. DOI: 10.3390/microorganisms11020359.

References

Rada A, Hernandez-Gomez C, Restrepo E, Villegas M . Distribution and molecular characterization of beta-lactamases in Gram-negative bacteria in Colombia, 2001-2016. Biomedica. 2019; 39(s1):199-220. DOI: 10.7705/biomedica.v39i3.4351. View

Mota R, Pinto M, Palmeira J, Goncalves D, Ferreira H . Multidrug-resistant bacteria as intestinal colonizers and evolution of intestinal colonization in healthy university students in Portugal. Access Microbiol. 2021; 3(1):acmi000182. PMC: 8115976. DOI: 10.1099/acmi.0.000182. View

Woodford N, Ellington M, Coelho J, Turton J, Ward M, Brown S . Multiplex PCR for genes encoding prevalent OXA carbapenemases in Acinetobacter spp. Int J Antimicrob Agents. 2006; 27(4):351-3. DOI: 10.1016/j.ijantimicag.2006.01.004. View

Hernandez-Gomez C, Blanco V, Motoa G, Correa A, Vallejo M, Villegas M . [Evolution of antimicrobial resistance in Gram negative bacilli from intensive care units in Colombia]. Biomedica. 2014; 34 Suppl 1:91-100. DOI: 10.1590/S0120-41572014000500011. View

Rezende T, Doi A, Quiles M, Pignatari A, Manfrendi S, Grothe C . Detection of colonization by carbapenem-resistant organisms by real-time polymerase chain reaction from rectal swabs in patients with chronic renal disease. J Hosp Infect. 2017; 96(2):123-128. DOI: 10.1016/j.jhin.2017.03.021. View

Wendt R, Nickel O, Botsch A, Lindner M, Bethge A, Marx K . Low colonization rates with Multidrug-resistant Gram-negative bacteria in a German hospital-affiliated hemodialysis center. PLoS One. 2020; 15(10):e0240314. PMC: 7561126. DOI: 10.1371/journal.pone.0240314. View

Adler A, Baraniak A, Izdebski R, Fiett J, Salvia A, Samso J . A multinational study of colonization with extended spectrum β-lactamase-producing Enterobacteriaceae in healthcare personnel and family members of carrier patients hospitalized in rehabilitation centres. Clin Microbiol Infect. 2014; 20(8):O516-23. DOI: 10.1111/1469-0691.12560. View

Leimbach A, Hacker J, Dobrindt U . E. coli as an all-rounder: the thin line between commensalism and pathogenicity. Curr Top Microbiol Immunol. 2013; 358:3-32. DOI: 10.1007/82_2012_303. View

Wirth T, Falush D, Lan R, Colles F, Mensa P, Wieler L . Sex and virulence in Escherichia coli: an evolutionary perspective. Mol Microbiol. 2006; 60(5):1136-51. PMC: 1557465. DOI: 10.1111/j.1365-2958.2006.05172.x. View

10.

Mughini-Gras L, Dorado-Garcia A, van Duijkeren E, van den Bunt G, Dierikx C, Bonten M . Attributable sources of community-acquired carriage of Escherichia coli containing β-lactam antibiotic resistance genes: a population-based modelling study. Lancet Planet Health. 2019; 3(8):e357-e369. DOI: 10.1016/S2542-5196(19)30130-5. View

11.

Lister P, Wolter D, Hanson N . Antibacterial-resistant Pseudomonas aeruginosa: clinical impact and complex regulation of chromosomally encoded resistance mechanisms. Clin Microbiol Rev. 2009; 22(4):582-610. PMC: 2772362. DOI: 10.1128/CMR.00040-09. View

12.

Munasinghe T, Vidanapathirana G, Kuthubdeen S, Ekanayake A, Angulmaduwa S, De Silva K . Colonization with selected antibiotic resistant bacteria among a cohort of Sri Lankan university students. BMC Infect Dis. 2021; 21(1):578. PMC: 8207576. DOI: 10.1186/s12879-021-06289-z. View

13.

Bezabih Y, Sabiiti W, Alamneh E, Bezabih A, Peterson G, Bezabhe W . The global prevalence and trend of human intestinal carriage of ESBL-producing Escherichia coli in the community. J Antimicrob Chemother. 2020; 76(1):22-29. DOI: 10.1093/jac/dkaa399. View

14.

Abdallah H, Alnaiemi N, Reuland E, Wintermans B, Koek A, Abdelwahab A . Fecal carriage of extended-spectrum β-lactamase- and carbapenemase-producing Enterobacteriaceae in Egyptian patients with community-onset gastrointestinal complaints: a hospital -based cross-sectional study. Antimicrob Resist Infect Control. 2017; 6:62. PMC: 5470242. DOI: 10.1186/s13756-017-0219-7. View

15.

Dallenne C, da Costa A, Decre D, Favier C, Arlet G . Development of a set of multiplex PCR assays for the detection of genes encoding important beta-lactamases in Enterobacteriaceae. J Antimicrob Chemother. 2010; 65(3):490-5. DOI: 10.1093/jac/dkp498. View

16.

Salazar-Ospina L, Vanegas J, Jimenez J . High intermittent colonization by diverse clones of β-lactam-resistant Gram-negative bacilli suggests an excessive antibiotic use and different sources of transmission in haemodialysis patients. J Hosp Infect. 2020; 107:76-86. DOI: 10.1016/j.jhin.2020.10.026. View

17.

Viau R, Frank K, Jacobs M, Wilson B, Kaye K, Donskey C . Intestinal Carriage of Carbapenemase-Producing Organisms: Current Status of Surveillance Methods. Clin Microbiol Rev. 2015; 29(1):1-27. PMC: 4771221. DOI: 10.1128/CMR.00108-14. View

18.

Costa R, Ferrari M, Bringer M, Darfeuille-Michaud A, Martins F, Barnich N . Characterization of mucosa-associated Escherichia coli strains isolated from Crohn's disease patients in Brazil. BMC Microbiol. 2020; 20(1):178. PMC: 7310525. DOI: 10.1186/s12866-020-01856-x. View

19.

Alconcher L, Rivas M, Lucarelli L, Galavotti J, Rizzo M . Shiga toxin-producing Escherichia coli in household members of children with hemolytic uremic syndrome. Eur J Clin Microbiol Infect Dis. 2019; 39(3):427-432. DOI: 10.1007/s10096-019-03738-1. View

20.

Clermont O, Christenson J, Denamur E, Gordon D . The Clermont Escherichia coli phylo-typing method revisited: improvement of specificity and detection of new phylo-groups. Environ Microbiol Rep. 2013; 5(1):58-65. DOI: 10.1111/1758-2229.12019. View