TY - JOUR
TI - Enterobacteriaceae bloodstream infections: Presence of integrons, risk factors, and outcome
AU - Daikos, G.L.
AU - Kosmidis, C.
AU - Tassios, P.T.
AU - Petrikkos, G.
AU - Vasilakopoulou, A.
AU - Psychogiou, M.
AU - Stefanou, I.
AU - Avlami, A.
AU - Katsilambros, N.
JO - Antimicrobial Agents and Chemotherapy
PY - 2007
VL - 51
TODO - 7
SP - 2366-2372
PB - 
SN - 0066-4804, 1098-6596
TODO - 10.1128/AAC.00044-07
TODO - beta lactamase;  extended spectrum beta lactamase, adult;  aged;  article;  bacteremia;  DNA sequence;  Enterobacter infection;  Enterobacteriaceae;  female;  follow up;  hospital infection;  human;  integron;  major clinical study;  male;  observational study;  outcome assessment;  polymerase chain reaction;  priority journal;  prospective study;  pulsed field gel electrophoresis;  risk factor, Bacteremia;  Community-Acquired Infections;  Cross Infection;  Disease Transmission, Professional-to-Patient;  DNA, Bacterial;  Drug Resistance, Multiple, Bacterial;  Electrophoresis, Gel, Pulsed-Field;  Enterobacteriaceae Infections;  Gene Transfer, Horizontal;  Humans;  Integrons;  Microbial Sensitivity Tests;  Nucleic Acid Amplification Techniques;  Polymerase Chain Reaction;  Prospective Studies;  Risk Factors;  Sequence Analysis, DNA;  Treatment Outcome
TODO - A prospective observational study was conducted to identify factors associated with bloodstream infections (BSIs) caused by integron-carrying Enterobacteriaceae and to evaluate the clinical significance of integron carriage. Consecutive patients with Enterobacteriaceae BSIs were identified and followed up until discharge or death. Identification of blood isolates and susceptibility testing were performed by the Wider I automated system. int-1-specific PCR, conserved-segment PCR, and DNA sequencing were used to determine the presence, length, and content of integrons. The relatedness among the isolates was examined by pulsed-field gel electrophoresis. Two hundred fifty episodes of Enterobacteriaceae BSI occurred in 233 patients; 109 (43.6%) were nosocomial, 82 (32.8%) were community acquired, and 59 (23.6%) were health care associated. Integrons were detected in 11 (13.4%) community-acquired, 24 (40.7%) health care-associated, and 46 (42.2%) nosocomial isolates. Integron-carrying organisms were more likely to exhibit resistance to three or more classes of antimicrobials (odds ratio [OR], 9.84; 95% confidence interval [95% CI], 5.31 to 18.23; P < 0.001) or to produce extended-spectrum β-lactamases (OR, 5.75; 95% CI, 2.38 to 13.89; P < 0.001) or a VIM-type metallo-β- lactamase (P, 0.003). Inter- or intraspecies integron transfer and cross-transmission of integron-carrying clones were observed. Use of cotrimoxazole (OR, 4.77; 95% CI, 1.81 to 12.54; P < 0.001) and a nosocomial or other health care setting (OR, 3.07; 95% CI, 1.30 to 7.22; P, 0.01) were independently associated with BSIs caused by integron-carrying Enterobacteriaceae. Patients with a nonurinary source of bacteremia (OR, 9.46; 95% CI, 2.77 to 32.32; P < 0.001) and a Pitt bacteremia score of ≥4 (OR, 23.36; 95% CI, 7.97 to 68.44; P < 0.001) had a significantly higher 14-day mortality rate, whereas integron carriage did not affect clinical outcomes. These findings may have implications affecting antibiotic policies and infection control measures. Copyright © 2007, American Society for Microbiology. All Rights Reserved.
ER -