LB 17 Rectal colonization with ESBL-producing organisms among Haitian transfers after the January 12th earthquake

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
L. Silvia Munoz-Price, MD , University of Miami, Miami, FL
Laurent Poirel, PhD , Hopital de Bicetre, Bicetre, France
Timothy Cleary , University of Miami, Miami, FL
Carolina de la Cuesta , University of Miami, Miami, FL
Gabriel Coro , Jackson Memorial Hospital, Miami, FL
Rafael Campo , University of Miami, Miami, FL
Gordon Dickson , University of Miami, Miami, FL
Paola Lichtenberger , University of Miami, Miami, FL
Patrice Nordmann , Hopital de Bicetre, Bicetre, France
Background: On January 12, 2010, an earthquake of magnitude 7.0 Mw struck southern Haiti. Within 24 hours after the earthquake, patients were transferred to south Florida hospitals, including Jackson Healthcare System.
Objective: To determine the degree of rectal colonization of patients with resistant Gram-negative organisms, and especially to evaluate the occurrence of extended-spectrum ß-lactamase (ESBL) producers.
Methods: Consecutive patients transferred from Haiti to Jackson Memorial Hospital (a 1,500 bed teaching hospital) underwent rectal swab cultures within 72 hours of admission. Swabs (BBL culture swabs-Becton Dickinson) were platted in 3 different media: MacConkey, Chrom ID ESBL (Biomerieux, France), and MacConkey with ceftazidime 4 ug/ml. Antibiograms were subsequently performed on solid agar plates by selecting different colonies according to their colour and morphology. Production of an ESBL was confirmed by a double disk synergy test using ceftazidime or cefotaxime and a clavulanic acid-containing disk.
Results: From January 12th until February 8th 2010, a total of 56 patients were admitted for over 24 hours to Jackson Memorial Hospital. Forty six patients have been screened, from which 19 (41%) were positive for ESBL producing Gram-negatives. The percentage of colonization among patients admitted increased during the weeks after the earthquake. Most of the ESBL-producing isolates were E. coli, but some K. pneumoniae and E. cloacae isolates were also identified. Interestingly, we identified some ESBL-positive A. baumannii isolates, although production of ESBLs in that species has been rarely documented in that species. Noteworthy, all the ESBL-producing Enterobacteriaceae remained susceptible to carbapenems. Almost all ESBLs identified were CTX-M-15. Four patients had more than one (2-5 strains) ESBL-producer strain isolated in their stool.
Conclusions: A high rate of colonization with ESBL-producing isolates was detected among Haitian transfers to a Miami hospital after the January 12th earthquake
Number of week post-earthquakeDatesNumber of patients admittedNumber of Haitian patients (%)Number of American citizensOther nationalitiesNumber of patients testedNumber of Patients positive for ESBL (%)
247 (29)161223 (14)
1915 (79)22147 (50)
65 (83)1054 (80)
77 (100)0055 (100)
5634 (61)1934619 (41)