title: High Prevalence of Gut Microbiota Colonization with Broad-Spectrum Cephalosporin ResistantEnterobacteriaceaein a Tunisian Intensive Care Unit.
abstract: Healthcare-associated infections due to cefotaxime-resistant (CTX-R)Enterobacteriaceaehave become a major public health threat, especially in intensive care units (ICUs). Often acquired nosocomially, CTX-REnterobacteriaceaecan be introduced initially by patients at admission. This study aimed to determine the prevalence and genetic characteristics of CTX-REnterobacteriaceae-intestinal carriage in ICU patients, to evaluate the rate of acquisition of these organisms during hospitalization, and to explore some of the associated risk factors for both carriage and acquisition. Between December 2014 and February 2015, the 63 patients admitted in the ICU of Charles Nicolle hospital were screened for rectal CTX-REnterobacteriaceaecolonization at admission and once weekly thereafter to identify acquisition. CTX-REnterobacteriaceaefecal carriage rate was 20.63% (13/63) at admission. Among the 50 non-carriers, 35 were resampled during their hospitalization and the acquisition rate was 42.85% (15/35). Overall, 35 CTX-REnterobacteriaceaeisolates were collected from 28 patients (25Klebsiella pneumoniae, sevenEscherichia coli, and threeEnterobacter cloacaestrains). Seven patients were simultaneously colonized with two CTX-REnterobacteriaceaeisolates. CTX-M-15 was detected in most of the CTX-REnterobacteriaceaeisolates (30/35, 88.23%). Three strains co-produced CMY-4 and 22 strains were carbapenem-resistant and co-produced a carbapenemase [OXA-48 (n= 13) or NDM-1 (n= 6)]. Molecular typing ofK. pneumoniaestrains, revealed eight Pulsed field gel electrophoresis (PFGE) patterns and four sequence types (ST) [ST101, ST147, ST429, and ST336]. However,E. coliisolates were genetically unrelated and belonged to A (n= 2), B1 (n= 2) and B2 (n= 3) phylogenetic groups and to ST131 (two strains), ST572 (two strains), ST615 (one strain) and ST617 (one strain). Five colonized patients were infected by CTX-REnterobacteriaceae(four with the same strain identified from their rectal swab and one with a different strain). Whether imported or acquired during the stay in the ICU, colonization by CTX-REnterobacteriaceaeis a major risk factor for the occurrence of serious nosocomial infections. Their systematic screening in fecal carriage is mandatory to prevent the spread of these multidrug resistant bacteria.
authors.affiliation: Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El ManarTunis, Tunisia; Faculty of Sciences of Tunis, University of Tunis El ManarTunis, Tunisia.
authors.forename: Elaa
authors.initials: E
authors.lastname: Maamar
authors.affiliation: Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar Tunis, Tunisia.
authors.forename: Sana
authors.initials: S
authors.lastname: Ferjani
authors.affiliation: Intensive Care Unit, Charles Nicolle Hospital Tunis, Tunisia.
authors.forename: Ali
authors.initials: A
authors.lastname: Jendoubi
authors.affiliation: Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El ManarTunis, Tunisia; Faculty of Sciences of Gafsa, University of GafsaGafsa, Tunisia.
authors.forename: Samia
authors.initials: S
authors.lastname: Hammami
authors.affiliation: Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar Tunis, Tunisia.
authors.forename: Zaineb
authors.initials: Z
authors.lastname: Hamzaoui
authors.affiliation: University Bordeaux, Microbiologie Fondamentale et Pathogénicité, UMR5234 Bordeaux, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Mayonnove-Coulange
authors.affiliation: Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El ManarTunis, Tunisia; Laboratory of Microbiology, Charles Nicolle HospitalTunis, Tunisia.
authors.forename: Mabrouka
authors.initials: M
authors.lastname: Saidani
authors.affiliation: Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El ManarTunis, Tunisia; Laboratory of Microbiology, Charles Nicolle HospitalTunis, Tunisia.
authors.forename: Aouatef
authors.initials: A
authors.lastname: Kammoun
authors.affiliation: Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El ManarTunis, Tunisia; Laboratory of Microbiology, Charles Nicolle HospitalTunis, Tunisia.
authors.forename: Amel
authors.initials: A
authors.lastname: Rehaiem
authors.affiliation: Intensive Care Unit, Charles Nicolle Hospital Tunis, Tunisia.
authors.forename: Salma
authors.initials: S
authors.lastname: Ghedira
authors.affiliation: Intensive Care Unit, Charles Nicolle Hospital Tunis, Tunisia.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Houissa
authors.affiliation: Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El ManarTunis, Tunisia; Laboratory of Microbiology, Charles Nicolle HospitalTunis, Tunisia.
authors.forename: Ilhem
authors.initials: I
authors.lastname: Boutiba-Ben Boubaker
authors.affiliation: Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El ManarTunis, Tunisia; Laboratory of Microbiology, Charles Nicolle HospitalTunis, Tunisia.
authors.forename: Amine
authors.initials: A
authors.lastname: Slim
authors.affiliation: University Bordeaux, Microbiologie Fondamentale et Pathogénicité, UMR5234 Bordeaux, France.
authors.forename: Veronique
authors.initials: V
authors.lastname: Dubois
keywords: ICU; cefotaxime resistance; gut colonization