1016
healthcare facilities. Challenges of C. auris detection emphasize the importance of collaboration between hospitals and the state health department to optimize laboratory capacity for rapid identification of emerging pathogens.
Acknowledgments. The content is solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.
Financial support. This work was supported by the Centers for Disease Control and Prevention (cooperative agreement no. NU50CK000397).
Potential conflicts of interest. All authors report no conflict of interest relevant to this article.
References
1. Lockhart SR, Etienne KA, Vallabhaneni S, et al. Simultaneous emergence of multidrug-resistant Candida auris on 3 continents confirmed by whole-genome sequencing and epidemiologic analysis. Clin Infect Dis 2017;64:134–140.
Leandro Reus Rodrigues Perez
2. Tsay S, Welsh RM, Adams EH, et al. Notes from the field: ongoing transmission of Candida auris in healthcare facilities—United States, June 2016–May 2017. MMWR Morb Mortal Wkly Rep 2017;66:514–515.
3. Welsh RM, Bentz ML, Shams A, et al. Survival, persistence, and isolation of the emerging multidrug-resistant pathogenic yeast Candida auris on a plastic health care surface. J Clin Microbiol 2017;55:2996–3005.
4. Cadnum JL, Shaikh AA, Piedrahita CT, Sankar T. Effectiveness of disinfectants against Candida auris and other Candida species. Infect Control Hosp Epidemiol 2017;38:1240–1243.
5. Mizusawa M., Miller H, Green R, et al. Can multidrug-resistant Candida auris be reliably identified in clinical microbiology laboratories? J Clin Microbiol 2017;55:638–640.
6. Atlanta. Candida auris clinical update—September 2017. Centers for Disease Control and Prevention website.
https://www.cdc.gov/fungal/diseases/candi- diasis/
c-auris-alert-09-17.html. Published 2017. Accessed November 2, 2017.
7. Atlanta. recommendations for identification of Candida auris. Centers for Disease Control and Prevention website.
https://www.cdc.gov/fungal/ diseases/candidiasis/
recommendations.html. Published 2017. Accessed November 8, 2017.
8. Connecticut Department of Public Health. A case of Candida auris infection at a Connecticut acute care hospital—June 2017. Connecticut Epidemiol 2017;37:9–10.
Nosocomial impact of prevalent β-lactamases from the community enterobacteriaceae: what to do when the resistance doesn’t go your way
Leandro Reus Rodrigues Perez PhD Hospital Mãe de Deus, Porto Alegre, Brazil
To the Editor—Enterobacteriaceae are a common cause of commu- nity- and hospital-acquired infections, and they have become increasingly resistant to many classes of antibiotics.1 Currently, the emergence of these multidrug-resistant (MDR) organisms has raised global concern, and they require immediate control and prevention.1,2 The movement of MDR Enterobacteriaceae into the commu-
nity in distinct ways (eg, patients with prior hospitalization or genetic determinants of resistance emerging from food or envir- onments) has significant nosocomial impact at the patient admission level and for infection control strategies.2 Although studies have found that patients asymptomatically
colonized with MDR organisms (eg, extended spectrumβ-lactamase (ESBL) and carbapenemase producers) constitute a reservoir for transmission of the pathogen to others,2,3 little is known about the resistance rates among these organisms in the community setting. Therefore, we conducted a survey to determine the prevalence of
MDR Enterobacteriaceae for which MDR was defined as non- susceptibility to at least 1 agent in 3 or more antimicrobial cate- gories. Urine samples were considered because the recovery of MDR organisms fromthese samples aremost commonly compared with others, especially when enterobacterial species are considered.
Author for correspondence: Leandro Reus Rodrigues Perez, PhD, Microbiology Unit,
Hospital Mãe de Deus, 286, José de Alencar street, 90610-000, Porto Alegre RS, Brazil. E-mail:
leandro.reus@
gmail.com
Cite this article: Perez L, et al. (2018). Nosocomial impact of prevalent β-lactamases
from the community enterobacteriaceae: what to do when the resistance doesn’tgoyour way. Infection Control & Hospital Epidemiology 2018, 39, 1016–1017. doi: 10.1017/ ice.2018.136
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
For theseMDR isolates, the pattern of antimicrobial susceptibility to a select panel of antibiotics was determined as well. Enterobacterial isolates were recovered from outpatients
between January 1 and December 26, 2016, in Porto Alegre city and its metropolitan area in southern Brazil. Patients with a first MDR-positive urine culture within 48 hours who were admitted from home were deemed to have community-acquired infection and/or colonization. Antimicrobial susceptibilities to amikacin, ceftriaxone, cipro-
floxacin, ertapenem, gentamicin, and trimethoprim/sulfa- methoxazole were determined by disk diffusion, and results were interpreted according to the Clinical and Laboratory Standards Institute (CLSI) protocols.4 Bacterial identification was performed using the MicroScan WalkAway system (Beckman Coulter, Brea, CA). Resistance mechanisms were detected by phenotypic testing and by gene detection using a previously described polymerase chain reaction (PCR) procedure.5 During the study period, a total of 12,193 urinary samples
from distinct patients were evaluated. An enterobacterial specie was recovered from 1,885 patients (15.4%). Of these 1,885 iso- lates, 114 (6.05%) were MDR. Among them, 80 isolates (80 of 1,885, 4.2%) were ESBL producers, including 65 Escherichia coli, 8 Enterobacter spp, and 7 Klebsiella spp. In addition, 12 isolates (0.63%) were non–carbapenemase-producing carbapenem- resistant Enterobacteriaceae (nCP-CRE): 7 Enterobacter spp, 4 Klebsiella spp, and 1 Proteus mirabilis. Also, 22 isolates (1.2%), all Klebsiella pneumoniae isolates, were Klebsiella pneumoniae carbapenemase (KPC) producers.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124 |
Page 125 |
Page 126 |
Page 127 |
Page 128 |
Page 129 |
Page 130 |
Page 131 |
Page 132 |
Page 133 |
Page 134 |
Page 135 |
Page 136 |
Page 137 |
Page 138 |
Page 139 |
Page 140
