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Enterobacter species in a pediatric hospital: horizontal transfer or selection in individual patients?
P de Man1, E van Der Veeke, M Leemreijze
1Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands. peter_de_man@franciscus.nl
Insights
Cross-transmission, not patient gut flora, primarily drives Enterobacter colonization in children. This study highlights hospital-acquired infections and the spread of resistant bacteria among young patients.
Area of Science:
- Microbiology
- Infectious Diseases
- Pediatrics
Background:
- Enterobacter species are significant nosocomial pathogens, particularly in pediatric settings.
- The predominant source of Enterobacter colonization has been presumed to be endogenous gut flora.
- Understanding transmission dynamics is crucial for infection control in hospitals.
Purpose of the Study:
- To investigate the longitudinal epidemiology of Enterobacter colonization in a pediatric hospital.
- To determine the primary sources and transmission routes of Enterobacter strains in hospitalized children.
- To assess the prevalence of cross-transmission versus endogenous selection of Enterobacter.
Main Methods:
- Longitudinal study of 171 children across 15 wards over two years.
- Isolation and characterization of 287 Enterobacter species.
- Molecular strain typing using random amplified polymorphic DNA (RAPD) and pulsed-field gel electrophoresis (PFGE).
Main Results:
- Identified 97 distinct Enterobacter DNA types and 199 colonization events.
- A predominant clone accounted for 111 isolates (39%) from 62 children.
- Cross-transmission was identified as a major route, with 34% of children colonized by strains found in 2-4 other patients, contradicting endogenous selection theories.
Conclusions:
- Cross-transmission plays a more significant role in Enterobacter colonization among hospitalized children than previously thought.
- Hospital infection control strategies should focus on preventing the spread of Enterobacter between patients.
- Findings challenge the assumption that resistant Enterobacter strains are primarily selected from a patient's own microbiota.
Abstract:
Enterobacter species were studied longitudinally in a children's hospital. In total, 287 Enterobacter isolates were obtained from 171 children in 15 different wards (from March 1995 through April 1997). Strains were typed by random amplified polymorphic DNA and pulsed-field gel electrophoresis, which were concordant in outcome. In total, 97 DNA types and 199 colonization events were identified. A predominant clone was isolated 111 times from 62 children; another clone was isolated 19 times from 10 patients. These clones caused 36% of all colonizations. In 34% of the children, Enterobacter clones were found in 2-4 patients. The remaining colonizations were due to unique Enterobacter isolates. A large proportion of the Enterobacter strains was acquired through cross-transmission. This finding contrasts with the prevailing opinion that resistant Enterobacter strains are selected primarily from the patient's own gut flora.