INCIDENCE AND RESISTANCE PROFILE OF CEDECEA sp. ISOLATED FROM HOSPITAL

1
INCIDENCE AND RESISTANCE PROFILE OF CEDECEA sp.
ISOLATED FROM HOSPITAL

• Marcelo M. Antunes1,2,3 Adriana A. Antunes4,5
• Galba M. Campos Takaki5
• 1Laboratório Central de Saúde Pública - LACEN,
  Recife/Brazil 2Hospital Barão de Lucena,
  Recife/Brazil 3 Universidade Federal Rural de
  Pernambuco - UFRPE, Recife/Brazil 4
  Pos-Graduation in Biological Sciences UFPE,
  Recife/Brazil 5Nucleus of Research of
  Environmental Sciences (NPCIAMB) - UNICAP,
  Recife/PE, Brazil Rua Fernandes Vieira, S/N, Boa
  Vista, Recife/PE/Brazil.
• Corresponding author mantunes_at_elogica.com.br
  adri_antunes_at_yahoo.com.br

2
Introduction

• Cedecea is a Gram negative bacillus, belonging to
  the Enterobacteriaceae family, formerly
  classified like CDC, enteric group 15, comprising
  5 species.
• It is an important cause of infectious processes,
  with increased relevance in the hospital
  environment due to its antimicrobial resistance
  pattern.
• The genus Cedecea was proposed in 1980 (4) and
  was formally published in 1981 (4). Cedecea
  davisae and C. lapagei were named in 1981 (4),
  and C. neteri was named in 1982 (5). In addition,
  there are two unnamed species Cedecea sp. 3 and
  Cedecea sp. 5 (4). All five species were defined
  on the basis of differences in phenotypic
  properties and DNA hybridization (66).

3

• Cedecea is phenotypically distinct from other
  genera in the Enterobacteriaceae family. Cultures
  are usually lipase positive (corn oil) and
  resistant to colistin and cephalothin (4). Those
  properties are also shared with Serratia, but
  Cedecea differs for being unable to hydrolyze
  gelatin or DNA.
• Cedecea has also been included in some of the
  commercial identification kits. Among the main
  sites of infection we can find the respiratory
  tract, the surgical area, the cardiovascular and
  urinary systems and osteoarticular points, along
  with widespread processes such as bacteremia and
  septicemia.
• The isolation of Cedecea from hospitals has been
  more and more frequent, being of significant
  relevance in the etiology of those infections.
  There are few studies involving isolated Cedecea
  in Brazilian hospitals.

4
Objective

• The present works main objective is to evaluate
  the presence of Cedecea in the hospital
  environment as an etiologic agent, offering a
  valuable contribution to the study of the
  infectious processes originated from this
  bacterium.

5
Materials and methods

• Microorganism
• A total of 52 Cedecea samples recovered from
  patients receiving medical care in a public
  hospital located in the city of Recife,
  Pernambuco state, Brazil, were collected from
  March 2000 to June 2003. Reference strains were
  used as controls.

6
Isolation and identification

• For the isolation, the methodology applied used
  Blood Agar Base and EMB Agar, incubated for 24 -
  48 hours at 37ºC.
• For the sample identification was used the
  conventional methodology including the following
  biochemical tests Glucose, Sucrose, Sorbitol,
  Raffinose, Rhamnose, Arabinose, Sorbitol,
  Adonitol, Melibiose, Urea, H2S production, Indole
  production, Lysine decarboxylase, Arginine
  dihydrolase, Ornithine, Trip-deaminase, Esculin
  hydrolysis, VP, Citrate, Malonate utilization,
  ONPG, Cl, Cf and Oxidase.
• For the determination of the sensitivity profile
  to the antimicrobials automated methodology from
  MicroScan (Dade Behring) was used, with panels
  neg. combo, according to the manufacturer's
  instructions, testing the following drugs
  Amikacin, Amp-Sulbactam, Ampicillin, Aztreonam,
  Cephalothin, Cefepime, Ceftazidime, Ceftriaxone,
  Ciprofloxacin, Gentamicin, Imipenem,
  Pip-Tazobactam and Sulfa-Trimethoprim.

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Isolation and identification Automated
methodology - MicroScan WalkAway-96 system (Dade
Behring).
8
Microscan panels

• For Cedecea detection the sensitivity test was
  carried out by microdilution, using an automated
  methodology from MicroScan, with panels Neg.
  Combo.
• Reformulated conventional (Neg. Combo Type 6)
  panels were inoculated, incubated, and read
  according to the manufacturer's directions,
  except for the total incubation time for the
  conventional panels that was 48 h. Both panel
  types were incubated in and interpreted with the
  Micro Scan WalkAway-96 system (Dade Behring).
• Rapid panels were read at 8, 11, and 15h the
  results were reported when growth in the control
  wells was acceptable. Conventional panels were
  read with the WalkAway system after 18 h and then
  examined visually.
• The minimal inhibitory concentration (MIC) was
  determined by microdilution method with Micro
  scan panels Neg. Combo, CLSI cutoff points were
  used to interpret MIC data.

9
Results

• In a total of 52 samples of Cedecea, with 13
  being from the Medical Clinic patients (25), 10
  from the Surgical Clinic patients (20), 8 from
  the Intensive Care Unit patients (15), 6 from
  the Neonatology patients (12), 5 from Pediatrics
  patients (9), 4 from Clinic patients (7), 3
  from Gynecology patients (6), 2 from
  Obstetrician patients (4) and 1 from blood
  dialysis patients (2).
• In a total of 52 isolated samples, 27 were
  identified and confirmed through biochemical
  tests as Cedecea lapagei (52), 19 were
  identified and confirmed through biochemical
  tests as Cedecea davisae (36) and 6 as Cedecea
  sp. 5 (12). From clinical material, 26 samples
  were isolated from urine (50), 10 samples from
  blood culture (20), 8 from veined catheter
  (15), 6 from secretion of surgical wound (11),
  1 from abscess material (2) and 1 from LCR (2).
  
• The sensibility profile of the isolates is
  presented, demonstrating a clear tendency to
  multi-resistance, with higher sensitivity for
  Fluoroquinolones and Carbapenems.

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Incidence by Cedecea sp.in hospitalar environment
- 52 samples collected from March 2000 to June
2003

• Environmental Samples
• Medical Clinic 13 25
• Surgical Clinic 10 19
• Intensive Care Unit 8 15
• Neonatology 6 12
• Pediatrics 5 9
• Clinic patients 4 7
• Ginecology 3 6
• Obstetrician 2 4
• Blood dyalisis 1 2

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Incidence of Cedecea in hospitalar environment
2000 a 2003 - 52 isolated samples
12
Results of biochemical tests by Cedecea lapagei
Glucose Lysine - Sucrose
- Arginine - Sorbitol - Ornithine
- Raffinose
- T.Deaminase - Rhamnose -
Esculin Arabinose - VP Inositol
- Citrate Adonitol - Malonate
Melibiose - ONPG - Urea - Cl
H2S - Cf Indole - Oxidase
-
13
  Results of biochemical tests by Cedecea
davisae
Glucose Lysine - Sucrose
- Arginine Sorbitol - Ornithine
- Raffinose
- T.Deaminase Rhamnose -
Esculin Arabinose - VP Inositol
- Citrate Adonitol - Malonate
- Melibiose - ONPG - Urea - Cl
H2S - Cf Indole - Oxidase
-
14
Clinical material by Cedecea sp. from hospitalar
environment - 52 samples collected from March
2000 to June 2003
15
Cedecea sp.Antimicrobial Sensibility profile
16
Conclusions

• According to the results obtained in the present
  study, it is possible to conclude that the
  incidence of Cedecea, what in our country is
  already real, corresponds to less than 1 of all
  registered infectious processes.
• The sensitivity profile presented few options to
  be used as treatment, being necessary not only to
  standardize the sensitivity tests, as well as to
  improve the studies in this area in order to
  achieve an efficient control of this pathogen in
  the hospital environment.

17
References

• 1. Perkins SR, Beckett TA, Bump CM. Cedecea
  davisae Bacteremia. J Clin Microbiol 1986
  24675-76.
• 2. Mensa J, Gatell JM, Jiménez de Anta MT, Prats
  G, Domínguez-Gil A. Guía de terapêutica
  antimicrobiana. Editorial Masson. Barcelona 2004
  184.
• 3. Eisenstein BI, Zaleznik DF. Enterobacteriaceae.
  Enfermedades Infecciosas. Principios y práctica,
  de Mandell, Douglas y Bennett. Editorial
  Panamericana. Madrid 2002 2782-95.
• 4. Grimont, P. A. D., F. Grimont, J. J. Farmer
  III, and M. A. Asbury. Cedecea davisae gen. nov.,
  sp. nov. and Cedecea lapagei sp. nov., new
  Enterobacteriaceae from clinical specimens. Int.
  J. Syst. Bacteriol. 1981 31317-326.
• 5. Farmer, J. J., III, N. K. Sheth, J. A.
  Hudzinski, H. D. Rose, and M. A.
  Asbury.Bacteremia due to Cedecea neteri sp. nov.
  J. Clin. Microbiol., 1982 16775-778.