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. 2018 May 22:7:67.
doi: 10.1186/s13756-018-0356-7. eCollection 2018.

Dynamics of colistin and tobramycin resistance among Enterobacter cloacae during prolonged use of selective decontamination of the digestive tract

M J D Dautzenberg  1   2   3 , J R Bayjanov  1 , M A Leverstein-van Hall  4   5 , A E Muller  4 , L B S Gelinck  6 , C L Jansen  4 , E M S Leyten  6 , T Ruys  7 , J Scharringa  1 , R E van der Starre  4 , A C Fluit  1 , M J M Bonten  1   2
Affiliations

Dynamics of colistin and tobramycin resistance among Enterobacter cloacae during prolonged use of selective decontamination of the digestive tract

M J D Dautzenberg et al. Antimicrob Resist Infect Control. .

Abstract

Background: A high prevalence of colistin resistance among E. cloacae isolates in two intensive care units (ICU) (of 16 and 6 beds) using selective digestive decontamination (SDD) since 1990 instigated a retrospective and prospective investigation to quantify the role of clonal transmission. SDD is topical application of colistin and tobramycin and systemic use of cefotaxime during the first days of ICU-admission.

Methods: Multi-resistant E. cloacae (MREb) was defined as ESBL production and/or tobramycin non-susceptibility and/or colistin non-susceptibility. Incidence of acquisition and prevalence of carriage with MREb was determined from microbiological culture results.

Results: Colistin-resistant E. cloacae was first detected in November 2009 and carriage was demonstrated in 141 patients until October 2014. Mean incidence of MREb acquisition was 4.61 and 1.86 per 1000 days at risk in ICUs 1 and 2, respectively, and the mean monthly prevalence of MREb in both ICUs was 7.0 and 3.1%, respectively, without a discernible trend in time. Conversion rates from carriage of colistin-susceptible to resistant E. cloacae were 0.20 and 0.13 per 1000 patient days, respectively. Whole genome sequencing of 149 isolates revealed eight clusters, with the number of SNPs of the largest two clusters ranging between 0 and 116 for cluster 1 (n = 49 isolates), and 0 and 27 for cluster 2 (n = 36 isolates), among isolates derived between 2009 and 2014.

Conclusions: This study demonstrates a stable low-level endemicity of MREb in two Dutch ICUs with prolonged use of SDD, which was characterized by the persistent presence of two clusters, suggesting incidental clonal transmission.

Keywords: Colistin resistance; Enterobacter cloacae; Intensive care unit; Selective digestive tract decontamination; Tobramycin resistance.

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Conflict of interest statement

Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Incidence of resistant E. cloacae on ICU 1. ESBL: extended-spectrum beta-lactamase, non-S: non-susceptible, R: resistant
Fig. 2
Fig. 2
Incidence of resistant E. cloacae on ICU 2. ESBL: extended-spectrum beta-lactamase, non-S: non-susceptible, R: resistant
Fig. 3
Fig. 3
Daily prevalence of ESBL producing and/or tobramycin non-susceptible and/or colistin-resistant E. cloacae, in ICU (ICU 1 and ICU 2)
Fig. 4
Fig. 4
Whole genome sequencing of selected E. cloacae isolates (full phylogenetic tree)
See this image and copyright information in PMC

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