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JAC Advance Access originally published online on August 4, 2006
Journal of Antimicrobial Chemotherapy 2006 58(4):853-856; doi:10.1093/jac/dkl316
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Emergence of multidrug-resistant Gram-negative bacteria during selective decontamination of the digestive tract on an intensive care unit

Nashwan Al Naiemi1,2, Edou R. Heddema1, Aldert Bart1, Evert de Jonge3, Christina M. Vandenbroucke-Grauls1,2, Paul H. M. Savelkoul2 and Birgitta Duim1,*

1 Academic Medical Center, Department of Medical Microbiology Amsterdam, The Netherlands 2 VU University Medical Center, Medical Microbiology and Infection Control Amsterdam, The Netherlands 3 Academic Medical Center, Department of Intensive Care Amsterdam, The Netherlands

Received 29 March 2006; returned 23 June 2006; revised 6 July 2006; accepted 12 July 2006

*Corresponding author. Academic Medical Center, Department of Medical Microbiology, L1-244, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Tel: +31-20-5665714; Fax: +31-20-5669745; E-mail: b.duim{at}amc.uva.nl

Objectives: During treatment with selective decontamination of the digestive tract (SDD), four multidrug-resistant (MDR) strains, three different Escherichia coli and one Klebsiella pneumoniae, were isolated from four patients not known as carriers of such MDR strains before their admission to the intensive care unit (ICU) in the Academic Medical Center (AMC) in Amsterdam. These isolates were extended-spectrum ß-lactamase (ESBL)-positive. We investigated whether this was due to interspecies transfer of resistance genes.

Methods: The MDR strains were typed by amplified fragment length polymorphism (AFLP) analysis. The plasmids from these strains were characterized by restriction fragment length polymorphism and the resistance genes were characterized by PCR and sequence analysis.

Results: The strains were genetically unrelated and contained identical plasmids with ESBL genes.

Conclusions: We identified an outbreak of plasmid-mediated ESBL genes during SDD treatment in the ICU. The use of third-generation cephalosporins in SDD is associated with the emergence of ESBLs. We conclude that identification of emerging MDR Gram-negative bacteria and recognition of resistance plasmid transfer during SDD treatment are crucial for optimal application of this regimen in ICUs.

Keywords: ESBLs , SDD , intensive care , resistance


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