Article

Outbreak of a novel Enterobacter sp carrying bla(CTX-M-15) in a neonatal unit of a tertiary care hospital in Tanzania

Weill Bugando University College of Health Sciences, P.O. Box 1464, Mwanza, Tanzania.
International journal of antimicrobial agents (Impact Factor: 4.3). 09/2011; 38(3):265-9. DOI: 10.1016/j.ijantimicag.2011.05.009
Source: PubMed

ABSTRACT

Enterobacter hormaechei and Cronobacter sakazakii are amongst the most important causes of outbreaks of neonatal sepsis associated with powdered milk. In this study, we report for the first time an outbreak of a novel Enterobacter sp. harbouring bla(CTX-M-15) in a neonatal unit in Tanzania. Seventeen Gram-negative enteric isolates from neonatal blood cultures were studied. Antibiotic susceptibility was assessed by disc diffusion testing, and the presence of the bla(CTX-M-15) gene was established by polymerase chain reaction (PCR) and sequencing. Isolates were typed by pulsed-field gel electrophoresis (PFGE). Identification by biochemical profiling was followed by nucleotide sequencing of 16S ribosomal DNA (rDNA), rpoB and hsp60 alleles. Environmental sampling was done and control measures were established. Isolates were initially misidentified based on their fermentation characteristics and agglutination as Salmonella enterica serotype Paratyphi. All isolates were resistant to multiple antibiotics, except for ciprofloxacin and carbapenems, and were found to harbour bla(CTX-M-15) on a 291-kb narrow-range plasmid. PFGE analysis indicated the clonal outbreak of a single strain, infecting 17 neonates with a case fatality rate of 35%. The same strain was isolated from a milk bucket. Phylogenetic analysis using 16S rDNA, rpoB and hsp60 sequences permitted no definitive identification, clustering the strains in the Enterobacter cloacae complex with similarities of 92-98.8%. The data describe an outbreak of a novel bla(CTX-M-15)-positive, multiresistant Enterobacter strain in an African neonatal unit that can easily be misidentified taxonomically. These data highlight the need for constant surveillance of bacteria harbouring extended-spectrum β-lactamases as well as improvements in hygiene measures in developing countries.

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Available from: Eugen Domann, Sep 03, 2014
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    • "In Tanzania, class A ESBLs were found in various samples from hospital settings (56, 57). "
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    ABSTRACT: Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBL) has been found all over the world, and risk factors for acquiring these bacteria involve hospital care and antibiotic treatment. Surveillance studies are present in Europe, North America, and Asia, but there is no summarizing research published on the situation in Africa. This review aims to describe the prevalence of ESBL-producing Enterobacteriaceae in hospital and community settings in Africa and the ESBL genes involved. A non-systematic literature search was performed in PubMed. All articles published between 2008 and 2012 were screened and read in full text. Relevant articles were assessed for quality of evidence and included in the review. Articles were divided into regional areas in Africa and tabulated. ESBL-producing Enterobacteriaceae in hospitalized patients and in communities varies largely between countries and specimens but is common in Africa. ESBLs (class A and D) and plasmid-encoded AmpC (pAmpC) were regularly found, but carbapenemases were also present. ESBL-producing Enterobacteriaceae in hospital and community settings in Africa is common. Surveillance of antimicrobial resistance needs to be implemented in Africa to tailor interventions targeted at stopping the dissemination of ESBL-producing Enterobacteriaceae.
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    • "In our study, the frequency of ESBL producing E. cloacae was higher in males (63.6%) than females (36.4%). A study carried out at tertiary care hospital, Tanzania reported 41.2% in males and 58.8% in females.16 A research work conducted at University Hospital, northwest Spain revealed 65.8% ESBL producers in males and 34.2% in females.17 "
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    Full-text · Article · Feb 2013 · Pakistan Journal of Medical Sciences Online
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    • "In neonatal intensive care units (NICUs), the spread of ESBL-producing Enterobacter species has been reported very rarely (Kartali et al.; 2002; Moriguchi et al., 2007; Mshana et al. 2011), and to our knowledge, significant nosocomial outbreaks due to the clonal dissemination of CTX-M-15-producing Enterobacter cloacae have not been described in newborns. "
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    ABSTRACT: Newborns are rarely infected by extended-spectrum beta-lactamase (ESBL)-producing members of the Enterobacteriaceae. In a neonatal intensive care unit, 14 newborns were infected or colonized by CTX-M-15-producing Enterobacter cloacae. All seven infected patients had underlying medical conditions, and five of them were treated successfully with meropenem, whilst one untreated patient died. Paediatric infections caused by multidrug-resistant ESBL-producing Enterobacter cloacae constitute a critical clinical and epidemiological issue.
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