title: Simultaneous gut colonisation and infection by ESBL-producing Escherichia coli in hospitalised patients.
abstract: BACKGROUND
  Extended spectrum betalactamase (ESBL)-producing organisms are a major cause of hospital-acquired infections. ESBL-producing Escherichia coli (E. coli) have been recovered from the hospital environment. These drug-resistant organisms have also been found to be present in humans as commensals. The present investigation intended to isolate ESBL-producing E. coli from the gut of already infected patients; to date, only a few studies have shown evidence of the gut microflora as a major source of infection.
  
  
  OBJECTIVE
  This study aimed to detect the presence of ESBL genes in E.coli that are isolated from the gut of patients who have already been infected with the same organism.
  
  
  METHODS
  A total of 70 non-repetitive faecal samples were collected from in-patients of our hospital. These in-patients were clinically diagnosed and were culture-positive for ESBL-producing E. coli either from blood, urine, or pus. Standard microbiological methods were used to detect ESBL from clinical and gut isolates. Genes coding for major betalactamase enzymes such as bla CTX-M , bla TEM, and bla SHV were investigated by polymerase chain reaction (PCR).
  
  
  RESULTS
  ESBL-producing E. coli was isolated from 15 (21 per cent) faecal samples of the 70 samples that were cultured. PCR revealed that out of these 15 isolates, the bla CTX-M gene was found in 13 (86.6 per cent) isolates, the bla TEM was present in 11 (73.3 per cent) isolates, and bla SHV only in eight (53.3 per cent) isolates. All 15 clinical and gut isolates had similar phenotypic characters and eight of the 15 patients had similar pattern of genes (bla TEM, bla CTX-M, and bla SHV) in their clinical and gut isolates.
  
  
  CONCLUSIONS
  Strains with multiple betalactamase genes that colonise the gut of hospitalised patients are a potential threat and it may be a potential source of infection.
authors.affiliation: Department of Clinical Microbiology, Pondicherry Institute of Medical Sciences, Pondicherry, India.
authors.forename: Johny
authors.initials: J
authors.lastname: Asir
authors.affiliation: Department of Clinical Microbiology, Pondicherry Institute of Medical Sciences, Pondicherry, India.
authors.forename: Shashikala
authors.initials: S
authors.lastname: Nair
authors.affiliation: Department of Clinical Microbiology, Pondicherry Institute of Medical Sciences, Pondicherry, India.
authors.forename: Sheela
authors.initials: S
authors.lastname: Devi
authors.affiliation: Department of Biotechnology, Pondicherry University, Pondicherry, India.
authors.forename: Kenchappa
authors.initials: K
authors.lastname: Prashanth
authors.affiliation: Department of Biotechnology, Pondicherry University, Pondicherry, India.
authors.forename: Rajagopalan
authors.initials: R
authors.lastname: Saranathan
authors.affiliation: Department of Clinical Microbiology, Pondicherry Institute of Medical Sciences, Pondicherry, India.
authors.forename: Reba
authors.initials: R
authors.lastname: Kanungo
keywords: ESBL E.coli; Stool; colonisation