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Objective: Fecal carriage of extended-spectrum [beta]-lactamase-producing enterobacteriaceae may contribute to the spread of extended-spectrum [beta]-lactamase-producing enterobacteriaceae into the community. The objective of this study was to assess the duration of fecal carriage after discharge and the occurrence of intrafamilial transmission.

Design: Case series.

Setting: Quaternary care children's hospital.

Patients: Patients colonized with extended-spectrum [beta]-lactamase-producing enterobacteriaceae at the neonatal ICU and the respective household members.

Interventions: Screening for intestinal extended-spectrum [beta]-lactamase-producing enterobacteriaceae colonization was done at 1, 2, 4, 6, 9, and 12 months after discharge. Genetic relatedness of isolated extended-spectrum [beta]-lactamase-producing enterobacteriaceae strains was determined using automated rep-PCR.

Results: Twenty-five neonates (case-patients) colonized with extended-spectrum [beta]-lactamase-producing enterobacteriaceae (one extended-spectrum [beta]-lactamase-Escherichia coli; six extended-spectrum [beta]-lactamase-Klebsiella pneumoniae; 11 extended-spectrum [beta]-lactamase-Klebsiella oxytoca; and seven extended-spectrum [beta]-lactamase-Serratia marcescens) were included. Duration of fecal carriage was longer (up to 1 yr) in case-patients colonized with Klebsiella species than in case-patients colonized with Serratia marcescens (<4 months). During follow-up, strains and species of extended-spectrum [beta]-lactamase-producing enterobacteriaceae different from the primary strain were found in four and three case-patients, respectively. In nine of 49 (18.4%) included household members, extended-spectrum [beta]-lactamase-producing enterobacteriaceae were found during the follow-up period. In two of nine colonized household members, the isolated extended-spectrum [beta]-lactamase-producing enterobacteriaceae was identical to the primary strains of the respective case-patients.

Conclusions: After intestinal colonization with extended-spectrum [beta]-lactamase-producing enterobacteriaceae at the neonatal ICU, infants potentially remain carriers during the first year after discharge. Intrafamilial spread has been proven.

(C)2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies