Background and Aims Neonatal infections caused by Extended-spectrum beta-lactamase (ESBL)-producing bacteria are associated with increased morbidity and mortality. No data are available on neonatal colonization with ESBL-producing bacteria in Ecuador. The study aimed to assess the proportion of intestinal colonization with ESBL-producing Enterobacteriacae and their resistance pattern among infants hospitalized at the neonatal intensive care unit, Cuenca, Ecuador.
Methods From February to April 2011, stool specimens were collected, every two weeks, from all hospitalized neonates. Rectal swabs were plated on Mac Conkey agar containing cefotaxime and ceftazidime. Species identification and susceptibility tests were confirmed with Vitek2 and the epidemiologic typing was performed using Diversilab (Both bioMérieux).
Results 137 specimens were collected from 78 patients and 61.5% of the neonates became colonized with ESBL. The majority of the strains were Escherichia coli (EC, 88.5%) followed by Klebsiella pneumoniae (KP, 11.5%). Gentamicin resistance occurred in 98.6% of the EC and 100% of the KP and ciprofloxacin resistance in 98.6% of the EC and 0% of the KP strains. All strains were susceptible to carbapenems. Epidemiologic typing divided the EC isolates in two clusters and one unique isolate and the KP isolates were divided in two clusters. All EC and KP had bla CTX-M group 1 except for the unique EC isolate that had bla CTX-M group 9.
Conclusions The high proportion of patients colonized with four clones of ESBL-producing bacteria, reinforces the necessity for implementing surveillance programs as well as improved infection control to prevent further spread of ESBL strains between hospitalized neonates.