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Urinary tract infections caused by endemic multi-resistant Enterobacter cloacae in a dialysis and transplantation
W Kamińska1, J Patzer, D Dzierzanowska
1The Children's Memorial Health Institute, Warsaw, Poland.
Abstract:
In the period 1994-1998, 42 multi-resistant Enterobacter cloacae isolates responsible for urinary tract infections (UTIs) were obtained from children hospitalized in our dialysis and transplantation unit. E. cloacae isolates obtained between 1994 and 1996 were susceptible to aminoglycosides, carbapenems and fluoroquinolones, whereas E. cloacae isolates obtained between 1997 and 1998 were susceptible to carbapenems and fluoroquinolones, only. All isolates were characterized by use of the polymerase chain reaction-based random amplification of polymorphic DNA and pulsed-field gel electrophoresis. It was found that the majority of multiresistant E. cloacae isolates obtained during 1997-1998, and all isolates obtained during 1994-1996, belonged to predominant clones A or B. These strains were responsible for gastrointestinal tract colonization and UTI of renal transplant recipients for several years, and persisted as endemic E. cloacae strains in the dialysis and transplantation unit from 1994 to 1998.
Insights
Multi-resistant Enterobacter cloacae caused urinary tract infections (UTIs) in children at a dialysis unit. Predominant clones A and B persisted, showing reduced susceptibility to antibiotics over time.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Enterobacter cloacae is an opportunistic pathogen.
- Multi-resistant strains pose a significant threat in healthcare settings, particularly in immunocompromised patients.
Purpose of the Study:
- To investigate the genetic relatedness and antibiotic susceptibility patterns of multi-resistant Enterobacter cloacae isolates from pediatric patients in a dialysis and transplantation unit.
Main Methods:
- Isolates were collected between 1994-1998 from children with urinary tract infections.
- Antibiotic susceptibility testing was performed.
- Molecular typing included random amplification of polymorphic DNA (RAPD) and pulsed-field gel electrophoresis (PFGE).
Main Results:
- 42 multi-resistant E. cloacae isolates were identified.
- Isolates from 1994-1996 were susceptible to aminoglycosides, carbapenems, and fluoroquinolones.
- Isolates from 1997-1998 showed reduced susceptibility, being resistant to aminoglycosides but susceptible to carbapenems and fluoroquinolones.
- Predominant clones A and B were identified, responsible for colonization and UTIs in renal transplant recipients.
- These clones persisted endemically from 1994 to 1998.
Conclusions:
- Predominant clones of multi-resistant E. cloacae established an endemic presence in the pediatric dialysis and transplantation unit.
- A concerning trend of decreasing susceptibility to certain antibiotic classes was observed over the study period.
- Molecular typing confirmed the clonal nature and persistence of these problematic strains.