title: Comparison of rates of fecal colonization with extended-spectrum beta-lactamase-producing enterobacteria among patients in different wards, outpatients and medical students.
abstract: Because asymptomatic carriage of extended-spectrum beta-lactamase (ESBL) producers is a risk factor for infection, data on colonization dynamics are important when planning infection control. This study investigated fecal colonization with ESBL producers among inpatients, outpatients and medical students and compares the characteristics of ESBL producers among these groups. Carriage rates were investigated in 5581 fecal samples; 4343 from inpatients (330, 1397, 619 and 1864 from adult ICUs [intensive care units], adult non-ICUs, pediatric ICUs and pediatric non-ICUs, respectively), 814 from outpatients and 424 from screening of medical students. ESBL producers were characterized by co-resistance, integrons carried, and aminoglycoside resistance and ESBL genes. Dynamic regression models were built to identify relationships between combinations of time series of monthly antibiotic consumption, prevalence of carriers and infected subjects. Inpatients, ICU patients and adults showed higher prevalence than outpatients, non-ICU patients or children (7.4%, 9.3% and 12.0% vs. 3.1%, 6.1% and 4.1%, respectively). Klebsiella pneumoniae was more frequent in ICU patients; dominance of CTX-M-15 producers was more marked in adult than in pediatric inpatients. ESBL carriage was shown to be a consequence of infection in adults in the time-series analysis; antibiotic consumption had little effect. The epidemiology of colonization with ESBL producers differed between pediatric ICU, adult ICU and adult non-ICU patients. In adults, carriage of ESBL producers seems to be the consequence of infection, especially in ICU patients; the main source of colonization is nosocomial acquisition. In contrast, children are less likely to acquire colonizer strains in hospitals; importation of ESBL producers by colonized children seems to be significant.
authors.affiliation: Department of Medical Microbiology, University of Debrecen.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Ebrahimi
authors.affiliation: Department of Medical Microbiology, University of Debrecen.
authors.forename: Julianna
authors.initials: J
authors.lastname: Mózes
authors.affiliation: Department of Medical Microbiology, University of Debrecen.
authors.forename: Júlia
authors.initials: J
authors.lastname: Monostori
authors.affiliation: Department of Medical Microbiology, University of Debrecen.|Clinical Pharmacy, Faculty of Medicine, University of Debrecen, H-4032 Debrecen Nagyerdei krt.98, Hungary.
authors.forename: Orsolya
authors.initials: O
authors.lastname: Gorácz
authors.affiliation: Department of Medical Microbiology, University of Debrecen.|Clinical Pharmacy, Faculty of Medicine, University of Debrecen, H-4032 Debrecen Nagyerdei krt.98, Hungary.
authors.forename: Adina
authors.initials: A
authors.lastname: Fésűs
authors.affiliation: Department of Medical Microbiology, University of Debrecen.
authors.forename: László
authors.initials: L
authors.lastname: Majoros
authors.affiliation: Department of Medical Microbiology, University of Debrecen.
authors.forename: Krisztina
authors.initials: K
authors.lastname: Szarka
authors.affiliation: Department of Medical Microbiology, University of Debrecen.
authors.forename: Gábor
authors.initials: G
authors.lastname: Kardos
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D004363:Drug Utilization; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology*; D006801:Humans; D007297:Inpatients; D032023:Integrons; D008826:Microbial Sensitivity Tests; D010045:Outpatients; D015995:Prevalence; D013337:Students, Medical; D001618:beta-Lactamases / Q000032:analysis*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases
keywords: antibiotic consumption; asymptomatic carriage; extended-spectrum beta-lactamase-producing Escherichia coli; extended-spectrum beta-lactamase-producing Klebsiella pneumoniae