Nosocomial transmission of highly resistant microorganisms on a spinal cord rehabilitation ward.
OBJECTIVE
To study the mechanism of nosocomial transmission of highly resistant microorganisms (HRMOs).


METHODS
A prospective observational study.


METHODS
A spinal cord ward of a rehabilitation center.


METHODS
Patients admitted to the spinal cord rehabilitation ward.


METHODS
HRMOs present in urine and feces. HRMOs, Enterobacteriaceae: (1) that produced an extended-spectrum beta-lactamase (ESBL), (2) that were resistant to carbapenems, (3) that fluoroquinolones and aminoglycosides (for Escherichia coli and Klebsiella species), or other Enterobacteriaceae species that were resistant to 2 of 3 of the following types of antibiotics (fluoroquinolones, aminoglycosides, cotrimoxazole).


METHODS
Bacterial growth, identification and sensitivity were tested in urine cultures of 46 patients and faeces cultures of 15 patients. Data were collected on demographic characteristics, underlying diseases, reason and date of admission, room number, method of catheterization (suprapubic, clean intermittent catheterization or indwelling Foley catheter) and antibiotic use.


RESULTS
Nine different HRMOs (7 E. coli, 1 Enterobacter cloacae, and 1 Citrobacter koseri) were isolated in urine samples from 15 patients. E. coli resistant to gentamicin, tetracycline, amoxicillin, cotrimoxazole, and ciprofloxacin were isolated from 8 patients during the study (cluster 1). One strain of multiresistant E coli found before the start of the study was not found during the study period (cluster 2). E coli strains producing an ESBL and resistant to tetracycline, cotrimoxazole, and ciprofloxacin were isolated from urine samples of 3 patients (cluster 3). Ciprofloxacin-resistant E. coli were present in feces of 3 patients (2 in cluster 1). Catheterization was found to be significantly more prevalent in patients with HRMOs. Most of the patients in cluster 1 were treated with antibiotics before the first isolation of the strain.


CONCLUSIONS
HRMOs from urine samples were strongly correlated with the use of catheterization. A close correlation was found between prior use of antibiotics and colonization of the urinary tract on the level of the individual patient, which has been rarely described in the literature.
Slim
Erik
E
Department of Rehabilitation, Academic Medical Center Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands. f.j.slim@amc.uva.nl
Smit
Christof A
CA
Bos
Arthur J
AJ
Peerbooms
Paul G
PG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology* / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D013119:Spinal Cord Injuries / Q000382:microbiology* / Q000652:urine
D000890:Anti-Infective Agents; D002939:Ciprofloxacin