Low colonization rates with Multidrug-resistant Gram-negative bacteria in a German hospital-affiliated hemodialysis center

Multidrug-resistant Gram-negative bacteria (MDRGN) are found with rising prevalence in non-hemodialysis risk populations as well as hemodialysis (HD) cohorts in Asia, Europe and North America. At the same time, colonization and consecutive infections with such pathogens may increase mortality and mo...

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Bibliographic Details
Published in:	PloS one Vol. 15; no. 10; p. e0240314
Main Authors:	Wendt, Ralph, Nickel, Olaf, Botsch, Almut, Lindner, Margareta, Bethge, Angela, Marx, Kathrin, Ruf, Bernhard R, Beige, Joachim, Lübbert, Christoph
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 15-10-2020 Public Library of Science (PLoS)
Subjects:	Analysis Anti-Bacterial Agents - pharmacology Antibiotics Antiinfectives and antibacterials Antimicrobial agents Bacteria beta-Lactamases - metabolism Biology and Life Sciences Carbapenems Chronic illnesses Colonization Consent Cross-Sectional Studies Drug Resistance, Multiple, Bacterial - drug effects E coli Enterobacter cloacae Ethics Feces - microbiology Fluoroquinolones Fluoroquinolones - pharmacology Genotype & phenotype Germany Gram-negative bacteria Gram-Negative Bacteria - chemistry Gram-Negative Bacteria - isolation & purification Gram-Negative Bacteria - metabolism Gram-Negative Bacterial Infections - microbiology Gram-Negative Bacterial Infections - pathology Gram-positive bacteria Hemodialysis Hemodialysis patients Hospitals Humans Hygiene Infections Infectious diseases Intestine Ionization Klebsiella Laboratories Mass spectrometry Mass spectroscopy Medicine Medicine and Health Sciences Microbial colonies Microbial drug resistance Microbial Sensitivity Tests Microbiology Morbidity Mortality Multidrug resistance Multidrug resistant organisms Nephrology Pathogens Patients People and Places Physical Sciences Populations Renal Dialysis Research and Analysis Methods Rheumatology Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization Staphylococcus infections Testing β Lactamase Germany United States > US Europe
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Summary:	Multidrug-resistant Gram-negative bacteria (MDRGN) are found with rising prevalence in non-hemodialysis risk populations as well as hemodialysis (HD) cohorts in Asia, Europe and North America. At the same time, colonization and consecutive infections with such pathogens may increase mortality and morbidity of affected individuals. We aimed to monitor intestinal MDRGN colonization in a yet not investigated German HD population. We performed cross-sectional point-prevalence testing with 12 months follow-up and selected testing of relatives in an out-patient HD cohort of n = 77 patients by using microbiological cultures from fresh stool samples, combined with Matrix Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF-MS) and antimicrobial susceptibility testing. We detected MDRGN in 8 out of 77 patients (10.4%) and 1 out of 22 relatives (4.5%), indicating only colonization and no infections. At follow-up, 2 patients showed phenotypic persistence of MDRGN colonization, and in 6 other patients de-novo MDRGN colonization could be demonstrated. Pathogens included Escherichia coli and Klebsiella pneumoniae (with extended-spectrum beta-lactamase [ESBL]-production as well as fluoroquinolone resistance), Stenotrophomonas maltophilia and Enterobacter cloacae. In a single-center study, MDRGN colonization rates were below those found in non-HD high-risk populations and HD units in the US, respectively. Reasons for this could be high hygiene standards and a strict antibiotic stewardship policy with evidence of low consumption of fluoroquinolones and carbapenems in our HD unit and the affiliated hospital.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: Author RW has received research speaker or consultation honoraria related to other projects from FMC and Alexion. Author JB has received research grants and speaker or consultation honoraria related to other projects from CVRx, Boehringer Ingelheim and Amgen. All other authors have no competing interests to declare. We confirm that our competing interest statement does not alter our adherence to PLOS ONE policies on sharing data and materials.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0240314