Journal of Antimicrobial Chemotherapy, Vol 39, 177-187, Copyright © 1997 by The British Society for Antimicrobial Chemotherapy
LJ Piddock, RN Walters, YF Jin, HL Turner, DM Gascoyne-Binzi and PM Hawkey
In a UK survey of the occurrence of extended spectrum beta-lactamases, 96
hospitals submitted a total of 3951 non-selected, non-duplicate isolates of
Enterobacteriaceae from 100 patients in each hospital, 206 of these
cultures being mixed and, therefore, discarded. These isolates were
initially screened for strains likely to produce extended-spectrum
beta-lactamases (ESBLs) by MIC determination of beta-lactams followed by a
bioassay, then disc approximation test and isoelectric focusing (IEF).
Isolates were further examined using two pairs of PCR primers for both
blaTEM and blaSHV genes. The ability of isolates to transfer resistance to
both cefotaxime and ceftazidime by conjugation and transformation were
examined. Four hundred and nine cefotaxime/ceftazidime-resistant isolates
(10.9%) were identified from the 3745 submitted isolates, of which 338
(9.0%) were Enterobacteriaceae, 29 Escherichia coli, 35 Klebsiella spp. and
seven Hafnia alveii. IEF suggested that 17 isolates produced an ESBL, which
was confirmed in most cases by PCR and hydrolysis, five isolates produced
an SHV enzyme by IEF, but not confirmed by PCR, and 11 had isoelectric
points in the range 8-9 suggesting a possible AmpC enzyme. Only two
isolates transferred the determinants. In the case of the Klebsiella spp.,
19 of the 24 ceftazidime-resistant/clavulanate- sensitive isolates were
positive by PCR for a blaSHV gene. No isolates were identified as carrying
blaTEM, although eight isolates had isoelectric points of 5-6.3, suggesting
the presence of a possible TEM beta-lactamase. The results for the H.
alveii isolates suggest that either an AmpC-like enzyme or a transferable
beta-lactamase which is not TEM/SHV is present. This study shows that a
wide range of genotypically and phenotypically different isolates of
Enterobacteriaceae producing ESBL-like enzymes is present throughout the UK
at a frequency of about 1% of unselected isolates. It is important that
surveillance of resistance to these clinically important antibiotics is
maintained as the occurrence of localized or more widespread outbreaks
caused by bacteria producing ESBLs is to be expected.
JOURNAL ARTICLE
Prevalence and mechanism of resistance to 'third-generation' cephalosporins in clinically relevant isolates of Enterobacteriaceae from 43 hospitals in the UK, 1990-1991
Department of Infection, The Medical School, University of Birmingham, UK. l.j.v.piddock@bham.ac.uk
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