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Antimicrob. Agents Chemother. doi:10.1128/AAC.00044-07
Copyright (c) 2007, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights Reserved.

Enterobacteriaceae Bloodstream Infections: Presence of Integrons, Risk factors and Outcome

First Department of Propaedeutic Medicine, Department of Microbiology, National and Kapodistrian University of Athens, and Department of Clinical Microbiology, Laiko General Hospital, Athens, Greece

^* To whom correspondence should be addressed. Email: gdaikos{at}med.uoa.gr.

	Abstract

A prospective observational study was conducted to identify factors associated with bloodstream infections (BSIs) caused by integron-carrying Enterobacteriaceae and to evaluate the clinical significance of integron-carriage. Consecutive patients with Enterobacteriaceae BSIs were identified and followed up until discharge or death. Identification of blood isolates and susceptibility testing were performed by the Wider I automated system. Int1-specific polymerase chain reaction (PCR), conserved-segment PCR, and DNA sequencing were used to determine the presence, length, and content of integrons. The relatedness among the isolates was examined by pulse-field gel electrophoresis. Two hundred fifty episodes of Enterobacteriaceae BSIs occurred in 233 patients; 109 (43.6%) were nosocomial, 82 (32.8%) community-acquired, and 59 (23.6%) health-care associated. Integrons were detected in 11 (13.4%) community-acquired, in 24 (40.7%) health-care associated and in 46 (42.2%) nosocomial isolates. Integron-carrying organisms were more likely to exhibit resistance to three or more classes of antimicrobials (OR, 9.84; 95% CI, 5.31-18.23; P<0.001), to produce extended spectrum -lactamases (OR, 5.75; 95% CI, 2.38-13.89; P<0.001), or a VIM type metallo--lactamase (P, 0.003). Inter- or intra-species integron transfer and cross-transmission of integron-carrying clones were observed. Use of co-trimoxazole (OR, 4.77; 95% CI, 1.81-12.54; P<0.001) and the nosocomial or other health-care settings (OR, 3.07; 95% CI, 1.30-7.22; P=0.01) were independently associated with BSIs caused by integron-carrying Enterobacteriaceae. Patients with non-urinary source of bacteremia (OR, 9.46; 95%CI, 2.77-32.32; P<0.001) and Pitt bacteremia score 4 (OR, 23.36; 95%CI, 7.97-68.44; P<0.001) had significantly higher 14-day mortality, whereas integron-carriage did not affect clinical outcomes. These findings may have implications affecting antibiotic policies and infection-control measures.

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