Assessment of extended-spectrum [beta]-lactamases and integrons among Enterobacteriaceae in device-associated infections: multicenter study in north of Iran

• Published in: Antimicrobial resistance & infection control 2016-12, Vol.5 (1)
• Main Authors: Bagheri-Nesami, Masoumeh, Rafiei, Alireza, Eslami, Gohar, Ahangarkani, Fatemeh, Rezai, Mohammad Sadegh, Nikkhah, Attieh, Hajalibeig, Azin
• Format: Article
• Language: English
• Subjects: Development and progression; Drug resistance in microorganisms; Enterobacteriaceae infections; Genetic aspects; Health aspects; Integrons; Medical equipment; Physiological apparatus
• ISSN: 2047-2994; 2047-2994
• DOI: 10.1186/s13756-016-0143-2

Background Device-associated nosocomial infections (DA-NIs), due to MDR Enterobacteriaceae, are a major threat to patient safety in ICUs. We investigated on Extended-spectrum [beta]-lactamases (ESBL) producing Enterobacteriaceae and incidence of integrons in these bacteria isolated from ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTIs) in 18 governmental hospitals in the north of Iran. Methods In this cross-section study, the antibiotic susceptibility test was performed using the MIC method; also, phenotypically detection of ESBL-producing bacteria was carried out by the double-disk synergy (DDS) test. Presence of ESBL-related genes and integron Classes 1 and 2 was evaluated by the PCR method. Results Out of a total of 205 patients with DA-NIs, Enterobacteriaceae were responsible for (72.68%) of infections. The most common DA-NIs caused by Enterobacteriaceae were VAP (77.18%), CAUTI (19.46%), and sepsis due to VAP (3.35%). The most frequently Enterobacteriaceae were; Klebsiella pneumoniae 75 (24; 32% ESBL positive), E. coli 69 (6; 8.69% ESBL positive) and Enterobacter spp. 5 (5; 100% ESBL positive). Distribution of ESBL-related genes was as follows: bla-SHV (94.3%), bla-CTX (48.6%), bla-VEB (22.9%) and bla-GES (17.14%). The incidence rate of integron class 1 and class 2 was (82.92%) and (2.9%) respectively. Eight types of ESBL-producing bacteria were observed. Conclusions Due to the fact that the emergence rate of ESBL Enterobacteriaceae is increasing in DA-NIs, co-incidence of different types of ESBL genes with integrons in 75-100% of strains in our study is alarming for clinicians and healthcare safety managers. Therefore, regional and local molecular level estimations of ESBLs that are agents of DA-NIs are critical for better management of empiric therapy, especially for patients in ICUs.