Ann Lab Med 2020; 40(2): 164-168  https://doi.org/10.3343/alm.2020.40.2.164
Prevalence and Risk Factors for Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae Colonization in Intensive Care Units
Young Ah Kim, M.D.1, Yoon Soo Park, M.D.2,3, Banseok Kim, M.D.1, Young Hee Seo, B.D.4,
and Kyungwon Lee, M.D.4,5
Departments of 1Laboratory Medicine and 2Internal Medicine, National Health Insurance Service, Ilsan Hospital, Goyang, Korea; 3Department of Internal Medicine, 4Research Institute of Bacterial Resistance, and 5Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
Corresponding author: Yoon Soo Park, M.D.
Department of Internal Medicine, National Health Insurance Service, Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang 10444, Korea
Tel: +82-31-900-0979 Fax: +82-31-900-0343 E-mail: yspark@nhimc.or.kr

Young Ah Kim, M.D.
Department of Laboratory Medicine, National Health Insurance Service, Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang 10444, Korea
Tel: +82-31-900-0908 Fax: +82-31-900-0912 E-mail: yakim@nhimc.or.kryakim@nhimc.or.kr
Received: May 9, 2019; Revised: June 26, 2019; Accepted: October 1, 2019; Published online: March 1, 2020.
© Korean Society for Laboratory Medicine. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Active surveillance culture (ASC) can help detect hidden reservoirs, but the routine use of ASC for extended spectrum β-lactamase-producing Enterobacteriaceae is controversial in an endemic situation. We aimed to determine the prevalence and risk factors of extended spectrum β-lactamase-producing Klebsiella pneumoniae (EBSL-Kpn) colonization among intensive care unit (ICU)-admitted patients. Prospective screening of ESBL-Kpn colonization was performed for ICU-admitted patients within 48 hours for two months. A perirectal swab sample was inoculated on MacConkey agar supplemented with 2 µg/mL ceftazidime. ESBL genotype was determined by PCR-sequencing, and clonal relatedness was evaluated by pulsed-field gel electrophoresis (PFGE). The risk factors of ESBL-Kpn colonization were evaluated. The ESBL-Kpn colonization rate among the 281 patients at ICU admission was 6.4% (18/281), and blaCTX-M-15 was detected in all isolates. ESBL producers also showed resistance to fluoroquinolone (38.9%, 7/18). All isolates had the same ESBL genotype (blaCTX-M-15) and a highly clustered PFGE pattern, suggesting cross-transmission without a documented outbreak. In univariate analysis, the risk factor for ESBL-Kpn colonization over the control was the length of hospital stay (odds ratio=1.062; P=0.019). Routine use of ASC could help control endemic ESBL–Kpn for ICU patients.
Keywords: Colonization, Extended spectrum β-lactamase, Klebsiella pneumoniae, Prevalence, Risk factor



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