title: Prevalence of urinary colonization by extended spectrum-beta-lactamase Enterobacteriaceae among catheterised inpatients in Italian long term care facilities.
abstract: BACKGROUND
  Long Term Care Facilities (LTCFs) play a key role in guaranteeing care to patients in developed countries. Many patients, mostly elderly, access LTCFs at some time in their lives, and their healthcare pathways often require them to move back and forth between hospital and outpatient settings. These patterns bring about new challenges regarding infection control, especially healthcare associated infections.
  
  
  METHODS
  A point prevalence study was conducted in 23 Italian LTCFs, to identify colonization in patients with urinary catheter (>24 hours). Species identification, susceptibility tests and extended spectrum beta lactamase (ESBL) production screenings were performed using Vitek 2 System. Enterobacteria identified by Vitek 2 System as ESBL-producers or suspected AmpC hyperproducers on the basis of cephamycin resistance, were sent to a research laboratory where they underwent a double-disk synergy test. Finally, ESBL-producers were screened for bla resistance genes by PCR assay.
  
  
  RESULTS
  211 patients with catheter were screened, 185 out of 211 patients showed positive samples for the presence of Enterobacteriaceae, 114 of these 185 patients were colonized by extended spectrum cephalosporins resistant microorganisms. We identified a total of 257 Gram negative pathogens, of which 51.8% (133/257) were extended spectrum cephalosporins resistant. 7 out of 133 cephamycin not susceptible strains proved to be AmpC-type beta-lactamases and 125/133 ESBL-producers; 1 was not further characterized. 43 out of 257 (16.7%) E. coli, 37/257 (14.4%) P. mirabilis, 20/257 (7.8%), P. stuartii, 14/257 (5.4%) M. morganii, 7/257 (2.7%), K. pneumoniae, 4/257 (1.6%) C. koseri proved to be overall ESBL-producers by double-disk synergy test. Third and fourth generation cephalosporin resistant P. mirabilis, P. stuartii and M. morganii strains mainly harboured a blaTEM gene (95.9%), while 89.1% of E. coli were positive for the blaCTX-M determinant by PCR and sequencing. Patients with decubitus had a higher risk of colonization by at least one resistant isolate (p < 0.01). Samples of patients undergoing antibiotic therapy and patients with decubitus showed a higher risk (p < 0.05) of colonization by beta-lactam resistant microorganisms.
  
  
  CONCLUSIONS
  These data confirm the presence of high percentages of ESBL-positive Enterobacteria in Italian LTCFs and the predominance of CTX-M type ESBL in E. coli. The alarming presence of ESBL-producing Enterobacteriaceae in Italian LTCFs can seriously compromise the effectiveness of antibiotic therapy.acilities (LTCFs), Antimicrobial resistance.
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, Udine, Italy. arnoldo.luca@libero.it
authors.forename: Luca
authors.initials: L
authors.lastname: Arnoldo
authors.forename: Roberta
authors.initials: R
authors.lastname: Migliavacca
authors.forename: Laura
authors.initials: L
authors.lastname: Regattin
authors.forename: Annibale
authors.initials: A
authors.lastname: Raglio
authors.forename: Laura
authors.initials: L
authors.lastname: Pagani
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Nucleo
authors.forename: Melissa
authors.initials: M
authors.lastname: Spalla
authors.forename: Francesca
authors.initials: F
authors.lastname: Vailati
authors.forename: Antonella
authors.initials: A
authors.lastname: Agodi
authors.forename: Adriana
authors.initials: A
authors.lastname: Mosca
authors.forename: Carla
authors.initials: C
authors.lastname: Zotti
authors.forename: Stefano
authors.initials: S
authors.lastname: Tardivo
authors.forename: Ines
authors.initials: I
authors.lastname: Bianco
authors.forename: Adele
authors.initials: A
authors.lastname: Rulli
authors.forename: Paola
authors.initials: P
authors.lastname: Gualdi
authors.forename: Pietro
authors.initials: P
authors.lastname: Panetta
authors.forename: Carlo
authors.initials: C
authors.lastname: Pasini
authors.forename: Mino
authors.initials: M
authors.lastname: Pedroni
authors.forename: Silvio
authors.initials: S
authors.lastname: Brusaferro
mesh_terms: D000369:Aged, 80 and over; D002353:Carrier State / Q000382:microbiology* / Q000652:urine*; D003430:Cross-Sectional Studies; D004755:Enterobacteriaceae / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000382:microbiology* / Q000652:urine*; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D015995:Prevalence; D012044:Regression Analysis; D014546:Urinary Catheterization / Q000009:adverse effects; D014556:Urine / Q000382:microbiology; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000235:genetics
chemical_list: D001618:beta-Lactamases