High frequency of extended-spectrum beta-lactamase-producing Enterobacteriaceae carriers at a Japanese long-term care hospital |
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| Institution: | 1. Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan;2. Clinical Laboratory, Marugame Medical Center, Kagawa, Japan;3. Department of Nursing, Marugame Medical Center, Kagawa, Japan;4. Microbiology Division, Clinical Laboratory, Okayama University Hospital, Okayama, Japan;1. Department of Infectious Diseases, St. Luke''s International Hospital: 9-1, Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan;2. Graduate School of Public Health, St. Luke''s International University: OMURA Susumu & Mieko Memorial St. Luke''s Center for Clinical Academia, 5th Floor, 3-6-2, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan;1. Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan;2. Department of Pathology and Laboratory Medicine, National Defense Medical College, Japan;3. Division of Hematology Medicine, Department of Internal Medicine, National Defense Medical College, Japan;4. Department of Basic Pathology, National Defense Medical College, Japan;1. Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Nagakute, 480-1195, Aichi, Japan;2. Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA;3. Division of Biostatistics, Clinical Research Center, Aichi Medical University, Nagakute, 480-1195, Aichi, Japan;4. Department of Pharmacy, Mie University Hospital, Tsu, 514-0001, Mie, Japan;5. Department of Clinical Pharmaceutics, Division of Clinical Medical Science, Mie University Graduate School of Medicine, Tsu, 514-0001, Mie, Japan;6. Department of Molecular Epidemiology and Biomedical Sciences, Aichi Medical University, Nagakute, 480-1195, Aichi, Japan;1. Department of Otorhinolaryngology-Head and Neck Surgery, Wakayama Medical University, Kimiidera 811-1, Wakayama City, Wakayama, 641-8509, Japan;2. Sugita ENT Clinic, Mihama-Ku Takasu 3-14-1, Chiba City, Chiba, 261-0004, Japan;3. Department of Laboratory Medicine, Nagasaki University, Sakamoto 1-7-1, Nagasaki City, Nagasaki, 852-8501, Japan;4. Department of Medicine, University of Alabama at Birmingham, 1720 2nd Ave South Birmingham, Alabama, 35294, USA;1. Department of Internal Medicine, Hiroshima City Funairi Citizens Hospital, Hiroshima, Japan;2. Department of Dermatology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan;1. Laboratory of Infectious Diseases, Graduate School of Infection Control Sciences & ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641, Japan;2. Division of Clinical Laboratory, Byotai-Seiri Laboratory, 26-2 Ohyaguchikamicho Itabashi-ku, Tokyo, 173-0032, Japan;3. Division of Clinical Laboratory, Sanritsu Zelkova Veterinary Laboratory, 3-5-5 Ogibashi, Koto-ku, Tokyo, 135-0011, Japan |
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| Abstract: | IntroductionLong-term care hospitals (LTCHs) are at a high risk for the inflow and spread of antimicrobial resistance (AMR) pathogens. However, owing to limited laboratory resources, little is known about the extent to which AMR organisms are endemic.MethodsWe performed active surveillance for carbapenem-resistant Enterobacteriaceae (CRE) and extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) in newly admitted patients at Marugame Medical Center, a nearly 200-bedded LTCH located in Kagawa, Japan. From August to December 2021, we tested stool samples from patients wearing diapers and confirmed the genetic variants using specific PCR assays. We also collected clinical variables and compared them between AMR carriers and non-carriers.ResultsStool samples were collected from 75 patients, with a median age of 84 years. CRE strain was not detected, but 37 strains of ESBL-E were isolated from 32 patients (42.7%). During the study period, 4.9% of in-hospital patients (37 per 756 patients) were identified to be ESBL-E carriers in the routine microbiological processing, suggesting that active surveillance detected approximately 9-fold more ESBL-E carriers. The blaCTX-M-9 group was the most common (38.5%), followed by the blaTEM (26.9%). The clinical backgrounds of the ESBL-E non-carriers and carriers were not significantly different.ConclusionOur active screening demonstrated that nearly half of the patients hospitalized or transferred to a Japanese LTCH were colonized with ESBL-E. We highlight the enforcement of universal basic infection prevention techniques at LTCHs where patients carrying AMR pathogens gather. |
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| Keywords: | Aging society Antimicrobial resistance Extended-spectrum β-lactamase Infection prevention and control |
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