Outbreak of IMP-producing carbapenem-resistant Enterobacter gergoviae among kidney transplant recipients.

Autor:	Freire MP; Working Committee for Hospital Epidemiology and Infection Control, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil maristelapf@uol.com.br., de Oliveira Garcia D; Bacteriology Centre, Adolfo Lutz Institute, São Paulo, Brazil., Cury AP; Microbiology Section, Central Laboratory, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil., Spadão F; Working Committee for Hospital Epidemiology and Infection Control, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil., Di Gioia TS; Division of Microbiology, DASA Medicina Diagnóstica, São Paulo, Brazil., Francisco GR; Bacteriology Centre, Adolfo Lutz Institute, São Paulo, Brazil., Bueno MF; Bacteriology Centre, Adolfo Lutz Institute, São Paulo, Brazil., Tomaz M; Laboratory for Medical Research 54, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil., de Paula FJ; Renal Transplantation Unit, Department of Urology, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil., de Faro LB; Division of Microbiology, DASA Medicina Diagnóstica, São Paulo, Brazil., Piovesan AC; Renal Transplantation Unit, Department of Urology, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil., Rossi F; Microbiology Section, Central Laboratory, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil., Levin AS; Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil., David Neto E; Renal Transplantation Unit, Department of Urology, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil., Nahas WC; Renal Transplantation Unit, Department of Urology, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil., Pierrotti LC; Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil.
Jazyk:	angličtina
Zdroj:	The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2016 Sep; Vol. 71 (9), pp. 2577-85. Date of Electronic Publication: 2016 May 19.
DOI:	10.1093/jac/dkw165
Abstrakt:	Objectives: The objective of this study was to investigate a prolonged outbreak of carbapenem-resistant Enterobacter gergoviae (CREG) involving kidney transplant recipients (KTRs) between 2009 and 2014. Methods: A case-control study was undertaken. Controls (n = 52) were selected from CREG-negative KTRs. Surveillance cultures for CREG were collected weekly. Colonization was defined as isolation of CREG from surveillance samples or from clinical specimens, with no evidence of infection. We also investigated infection control practices at the facility. Results: Of 26 identified cases, 13 had had no known contact with another CREG-positive patient before the first positive culture. Seven patients (27%) developed infection. The site most often colonized was the urinary tract. During the study period two clusters were identified, one in 2009 and another in 2013-14. DNA sequencing revealed blaIMP-1 in all CREG tested. No environmental or hand cultures tested positive for CREG. An audit of infection control practices detected flaws in the handling and cleaning of urinary tract devices. Multivariate analysis identified advanced age, ureteral stent use, retransplantation and male gender as risk factors for CREG acquisition. Conclusions: An outbreak among KTRs caused by an unusual species of MDR bacteria may have resulted from a common source of contamination related to urinary tract devices. (© The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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