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Title: Emergency room: An unrecognized source of extended-spectrum β-lactamase producing escherichia coli and klebsiella pneumoniae
Authors: Pornsook Pornsinchai
Piriyaporn Chongtrakool
Pornphan Diraphat
Kanokrat Siripanichgon
Kumthorn Malathum
Mahidol University
Keywords: Medicine
Issue Date: 1-Jan-2015
Citation: Southeast Asian Journal of Tropical Medicine and Public Health. Vol.46, No.1 (2015), 51-62
Abstract: © 2015, SEAMEO TROPMED Network. All rights reserved. Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae are the leading causes of hospital-associated infections, but community-acquired cases are increasingly being reported. This study determined the prevalence of ESBL-producing E. coli and K. pneumoniae carriers, their bla genes and risk factors of 452 patients admitted to the emergency room (ER) of Ramathibodi Hospital, Mahidol University, Bangkok, Thailand between April and August 2011. Prevalence of ESBL-producing E. coli and K. pneumoniae from rectal swabs was 16.5% and 1.0%, respectively. Factors associated with ESBL-producing carriers were a previous history of hospital admission (p = 0.001) and visits to health care facilities (p = 0.002) during the previous 3 months. All ESBL-producing isolates were susceptible to imipenem, meropenem and ertapenem. The majority (78%) of ESBL-producing E. coli isolates showed very high resistance to cefotaxime and ceftriaxone (MIC50and MIC90> 256 μg/ml). ESBL-producing E. coli harbored chromosomal blaTEM(96%), blaCTX-M(70%) and blaSHV(1%), while 8%, 73% and 3%, respectively, were located on plasmid. The prevalence of these genes in ESBL-producing K. pneumoniae was 75%, 50% and 25%, respectively on chromosome; and 100%, 25% and 50%, respectively on plasmid. Nucleotide sequence analysis revealed that these bla genes were of the type blaTEM-1, blaTEM-116, blaCTX-M-15, blaCTX-M-161, blaSHV-12, blaSHV-28and blaSHV-148. Detailed epidemiologic and clinical characteristics of ER patients with history of prior hospital visits should be carried out to identify the ESBL-producing organisms they have acquired in order to institute appropriate treatment for these patients as well as control measures against further dissemination of these life-threatening organisms.
ISSN: 01251562
Appears in Collections:Scopus 2011-2015

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