title: Rates of fecal transmission of extended-spectrum β-lactamase-producing and carbapenem-resistant Enterobacteriaceae among patients in intensive care units in Korea.
abstract: BACKGROUND
  We investigated the rates of fecal transmission of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) and carbapenem-resistant Enterobacteriaceae (CRE) among patients admitted to intensive care units (ICUs).
  
  
  METHODS
  From June to August 2012, rectal cultures were acquired from all patients at ICU admission. For patients not carrying ESBL-E or CRE at admission, follow-up cultures were performed to detect acquisition. A chromogenic assay was used to screen for ESBL-E and CRE. Bacterial species identification and antibiotic susceptibility tests were performed using the Vitek 2 system (bioMérieux, France). ESBL genotypes were determined by PCR, and clonal relatedness of the isolates was assessed by pulsed-field gel electrophoresis.
  
  
  RESULTS
  Out of 347 ICU admissions, 98 patients were found to be carriers of ESBL-E (28.2%, 98/347). Follow-up cultures were acquired from 91 of the patients who tested negative for ESBL-E at admission; the acquisition rate in this group was 12.1% (11/91), although none was a nosocomial transmission. For CRE, the prevalence of fecal carriage was 0.3% (1/347), and the acquisition rate was 2.9% (4/140). None of the CRE isolates were carbapenemase-producers.
  
  
  CONCLUSIONS
  The high prevalence of ESBL-E carriage on admission (28.2%), coupled with rare nosocomial transmission and the very low carriage rate of CRE (0.3%), challenge the routine use of active surveillance in non-epidemic settings. Nevertheless, passive surveillance measures, such as rapid and accurate screening of clinical specimens, will be critical for controlling the spread of CRE.
authors.affiliation: Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea.
authors.forename: Jayoung
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Infection Control, Seoul St. Mary's Hospital, Seoul, Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Sang Il
authors.initials: SI
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Wonkeun
authors.initials: W
authors.lastname: Song
authors.affiliation: Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Jae-Seok
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Seungwon
authors.initials: S
authors.lastname: Jung
authors.affiliation: Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.
authors.forename: Jin Kyung
authors.initials: JK
authors.lastname: Yu
authors.affiliation: Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.
authors.forename: Kang Gyun
authors.initials: KG
authors.lastname: Park
authors.affiliation: Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.
authors.forename: Yeon-Joon
authors.initials: YJ
authors.lastname: Park
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000378:metabolism*; D015780:Carbapenems / Q000494:pharmacology*; D002353:Carrier State / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology / Q000635:transmission*; D004269:DNA, Bacterial / Q000032:analysis; D024881:Drug Resistance, Bacterial / Q000187:drug effects; D016521:Electrophoresis, Gel, Pulsed-Field; D004755:Enterobacteriaceae / Q000201:enzymology / Q000235:genetics / Q000502:physiology*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000635:transmission*; D005243:Feces / Q000382:microbiology*; D005838:Genotype; D006801:Humans; D007362:Intensive Care Units; D016133:Polymerase Chain Reaction; D015995:Prevalence; D056910:Republic of Korea / Q000453:epidemiology; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D004269:DNA, Bacterial; D001618:beta-Lactamases
keywords: CRE; CTX-M; Colonization; ESBL-E; Rectal swab; Transmission