Acquisition of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in intensive care units in Thailand

This study aimed to assess the prevalence and associated risk factors for extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae (ESBL-EK) acquisition among patients staying in medical and surgical Intensive Care Units (ICU) in Northern Thailand. Rectal swabs were collected from 206 ICU patients upon admission and discharge. Overall, the ESBL-EK acquisition rate among patients during ICU stay was 29.6%. Acquisition rate was significantly higher for K. pneumoniae (20.9%) than that of E. coli (12.1%) (p = 0.024). Multivariate logistic regression analysis identified the use of third generation cephalosporin (p = 0.008) as a risk factor for ESBL-EK acquisition. Sixty-eight ESBL-EK isolates (25 E. coli and 43 K. pneumoniae) were recovered. The majority of ESBL-EK isolates (>= 88%) were resistant to ceftazidime, cefepime and aztreonam. Fifty-two acquired ESBL-EK isolates (76.5%) were positive for bla(CTX-M) and 4 K. pneumoniae isolates simultaneously carried bla(NDM-1). Our results reveal that ICU patients could acquire ESBL-EK during hospitalization and the use of third generation cephalosporin should be strictly controlled to prevent the acquisition of ESBL-EK among ICU patients. (C) 2020 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Automated summary

This study assessed the prevalence and risk factors for ESBL-EK acquisition among ICU patients in Northern Thailand. The study found that the use of third generation cephalosporin was a risk factor for ESBL-EK acquisition, and the majority of ESBL-EK isolates were resistant to multiple antibiotics.