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JAC Advance Access published online on August 4, 2006
Journal of Antimicrobial Chemotherapy, 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
Received March 29, 2006
Revised July 6, 2006
Accepted July 12, 2006

Brief report

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

Nashwan Al Naiemi 1, Edou R. Heddema 2, Aldert Bart 2, Evert de Jonge 3, Christina M. Vandenbroucke-Grauls 1, Paul H. M. Savelkoul 4, and Birgitta Duim 2 *

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

* To whom correspondence should be addressed.
Birgitta Duim, E-mail: b.duim{at}amc.uva.nl


  Abstract

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 {beta}-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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