Journal of Antimicrobial Chemotherapy

JAC Advance Access originally published online on August 4, 2004

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Journal of Antimicrobial Chemotherapy 2004 54(3):628-633; doi:10.1093/jac/dkh397
JAC vol.54 no.3 © The British Society for Antimicrobial Chemotherapy 2004; all rights reserved.

Predominance and genetic diversity of community- and hospital-acquired CTX-M extended-spectrum ß-lactamases in York, UK

C. J. Munday¹, G. M. Whitehead², N. J. Todd², M. Campbell³ and P. M. Hawkey^1,4,*

¹ Antimicrobial Agents Research Group, Division of Immunobiology and Infection, The Medical School, University of Birmingham, Vincent Drive, Edgbaston, Birmingham B15 2TT; ² Department of Microbiology, York Hospital, Wigginton Road, York YO31 8HE; ³ Department of Biological and Biomedical Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA; ⁴ Birmingham Public Health Laboratory, Health Protection Agency, Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK

^* Corresponding author. Correspondence should be sent to the Birmingham Public Health Laboratory address. Tel: +44-121-424-1240; Fax: +44-121-772-6229; Email: peter.hawkey{at}heartsol.wmids.nhs.uk

Objectives: This study was conducted to detect the presence of extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae within the faecal flora of both community- and hospital-based patients in York and to characterize the bla_TEM, bla_SHV and bla_CTX-M genes present in these isolates.

Methods: One thousand faeces samples were collected and screened at York Hospital during October–December 2003. Ninety-five non-duplicate Enterobacteriaceae isolates resistant to third-generation cephalosporins were recovered; 22 isolates were selected for further study on the basis of a positive double disc diffusion test for ESBL production. Antibiotic susceptibility testing was performed to a range of antibiotics. The TEM, SHV and CTX-M genes were detected by PCR and the DNA sequenced.

Results: The distribution of ESBL-positive isolates from the hospital and community was 1.4:1. These included nine Escherichia coli, seven Enterobacter cloacae, four Citrobacter freundii and a single isolate each of Klebsiella spp. and Salmonella spp. A total of 17 isolates contained bla_CTX-M (five bla_CTX-M-15, three bla_CTX-M-14 and nine bla_CTX-M-9). ISEcp1 was present in isolates expressing CTX-M-14 and -15, but was absent upstream of In60-associated bla_CTX-M-9. E. coli isolates also contained either a bla_TEM-1 or bla_TEM-2, whereas six of the E. cloacae carried bla_SHV-12 and the Klebsiella spp. bla_SHV-36 in addition to bla_CTX-M-9. The single Salmonella spp. carried bla_SHV-12.

Conclusions: The overall prevalence of ESBL in isolates of Enterobacteriaceae from York was 1.9%. ESBL-producing isolates were found in both the community and hospital, with the CTX-M type most common. This is also the first report of an ESBL-producing Salmonella in the UK.

Keywords: ESBLs , Salmonella , Enterobacteriaceae

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