title: Fecal carriage and intrafamilial spread of extended-spectrum β-lactamase-producing enterobacteriaceae following colonization at the neonatal ICU.
abstract: OBJECTIVE
  Fecal carriage of extended-spectrum β-lactamase-producing enterobacteriaceae may contribute to the spread of extended-spectrum β-lactamase-producing enterobacteriaceae into the community. The objective of this study was to assess the duration of fecal carriage after discharge and the occurrence of intrafamilial transmission.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Quaternary care children's hospital.
  
  
  METHODS
  Patients colonized with extended-spectrum β-lactamase-producing enterobacteriaceae at the neonatal ICU and the respective household members.
  
  
  METHODS
  Screening for intestinal extended-spectrum β-lactamase-producing enterobacteriaceae colonization was done at 1, 2, 4, 6, 9, and 12 months after discharge. Genetic relatedness of isolated extended-spectrum β-lactamase-producing enterobacteriaceae strains was determined using automated rep-PCR.
  
  
  RESULTS
  Twenty-five neonates (case-patients) colonized with extended-spectrum β-lactamase-producing enterobacteriaceae (one extended-spectrum β-lactamase-Escherichia coli; six extended-spectrum β-lactamase-Klebsiella pneumoniae; 11 extended-spectrum β-lactamase-Klebsiella oxytoca; and seven extended-spectrum β-lactamase-Serratia marcescens) were included. Duration of fecal carriage was longer (up to 1 yr) in case-patients colonized with Klebsiella species than in case-patients colonized with Serratia marcescens (<4 months). During follow-up, strains and species of extended-spectrum β-lactamase-producing enterobacteriaceae different from the primary strain were found in four and three case-patients, respectively. In nine of 49 (18.4%) included household members, extended-spectrum β-lactamase-producing enterobacteriaceae were found during the follow-up period. In two of nine colonized household members, the isolated extended-spectrum β-lactamase-producing enterobacteriaceae was identical to the primary strains of the respective case-patients.
  
  
  CONCLUSIONS
  After intestinal colonization with extended-spectrum β-lactamase-producing enterobacteriaceae at the neonatal ICU, infants potentially remain carriers during the first year after discharge. Intrafamilial spread has been proven.
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria. volker.strenger@medunigraz.at
authors.forename: Volker
authors.initials: V
authors.lastname: Strenger
authors.forename: Gebhard
authors.initials: G
authors.lastname: Feierl
authors.forename: Bernhard
authors.initials: B
authors.lastname: Resch
authors.forename: Gernot
authors.initials: G
authors.lastname: Zarfel
authors.forename: Andrea
authors.initials: A
authors.lastname: Grisold
authors.forename: Lilian
authors.initials: L
authors.lastname: Masoud-Landgraf
authors.forename: Verena
authors.initials: V
authors.lastname: Dosch
authors.forename: Regina
authors.initials: R
authors.lastname: Riedl
authors.forename: Werner
authors.initials: W
authors.lastname: Zenz
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Müller
authors.forename: Berndt
authors.initials: B
authors.lastname: Urlesberger
mesh_terms: D002353:Carrier State / Q000382:microbiology*; D003428:Cross Infection / Q000382:microbiology; D004755:Enterobacteriaceae / Q000235:genetics / Q000378:metabolism*; D004756:Enterobacteriaceae Infections / Q000382:microbiology / Q000635:transmission*; D004926:Escherichia coli / Q000235:genetics / Q000302:isolation & purification; D005190:Family; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D041121:Klebsiella oxytoca / Q000235:genetics / Q000302:isolation & purification; D007711:Klebsiella pneumoniae / Q000235:genetics / Q000302:isolation & purification; D008297:Male; D012706:Serratia marcescens / Q000235:genetics / Q000302:isolation & purification; D013997:Time Factors; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D001618:beta-Lactamases