Journal of Antimicrobial Chemotherapy, Vol 40, 823-831, Copyright © 1997 by The British Society for Antimicrobial Chemotherapy
FH M'Zali, J Heritage, DM Gascoyne-Binzi, M Denton, NJ Todd and PM Hawkey
Sixteen strains of Escherichia coli with high-level resistance to
extended-spectrum cephalosporins and other classes of antibiotic have been
isolated at St James' University Hospital, Leeds. They produce up to three
separate beta-lactamases: TEM-1, SHV-5 and, in five isolates, a
plasmid-mediated AmpC-type enzyme. With the exception of carbapenems, the
isolates reported in this study were resistant to all beta-lactam
antibiotics including extended-spectrum cephalosporins and the monobactam
aztreonam. There was evidence of the spread of a plasmid encoding SHV-5,
particularly amongst patients on the liver transplant unit. Sensitivity to
beta-lactam antibiotics in five isolates expressing the AmpC-type
beta-lactamase was not restored by the beta- lactamase inhibitor clavulanic
acid. These bacteria also carried blaSHV- 5 on a large plasmid.
PCR-amplification of the structural gene and digestion with restriction
endonucleases demonstrated that the plasmid- mediated blaAmpC probably
identified as BIL-1 using the criteria available. Four of the five patients
carrying isolates that carried the plasmid-located blaAmpC gene had
recently visited the Indian subcontinent and we presume that they returned
carrying these bacteria. Restriction fragment length polymorphism analysis
using pulsed field gel electrophoresis (PFGE) suggests that at least four
distinct strains existed amongst these five isolates. The two isolates that
had very similar PFGE patterns had different plasmid profiles and were
isolated from different locations in the hospital and at different times.
This study demonstrates the ease with which highly resistant bacteria can
be imported into the UK and spread within hospitals.
ORIGINAL ARTICLES
Transcontinental importation into the UK of Escherichia coli expressing a plasmid-mediated AmpC-type beta-lactamase exposed during an outbreak of SHV-5 extended-spectrum beta-lactamase in a Leeds hospital
Department of Microbiology, University of Leeds, UK.
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