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JAC Advance Access originally published online on December 1, 2004
Journal of Antimicrobial Chemotherapy 2005 55(1):119-122; doi:10.1093/jac/dkh517
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JAC vol.55 no.1 © The British Society for Antimicrobial Chemotherapy 2004; all rights reserved

Integron-mediated ESBL resistance in rare serotypes of Escherichia coli causing infections in an elderly population of Israel

David Sompolinsky1,2,*, Yeshayahu Nitzan1,*, Shaul Tetry1,2, Moshe Wolk3, Israel Vulikh2, Mette Barendorff Kerrn4, Dorthe Sandvang4, Gitit Hershkovits1,* and Don J. Katcoff1,*,{dagger}

1 Faculty of Life Sciences, Bar Ilan University, Ramat Gan 52900; 2 Microbiology Laboratory, Ma'aynei-Hayeshua Hospital, Bnei Brak; 3 Ministry of Health Central Laboratories, Jerusalem, Israel; 4 Division of Microbiology, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark

{dagger} Corresponding author. Tel: 972-3-5318248; Fax: 972-3-5351824; Email: katcoff{at}mail.biu.ac.il

Objectives: To identify and characterize the aetiology of an outbreak of extra-intestinal multidrug-resistant Escherichia coli infections in elderly patients in Israel.

Methods: Extended-spectrum ß-lactamase (ESBL)-producing clinical isolates of E. coli from extra-intestinal sources were tested for susceptibility to non-ß-lactam drugs, and their serotypes were determined. Restriction enzyme digestion, followed by PFGE of DNA purified from isolates, was used to classify the phylogenetic relationship between them. Plasmid DNA from five isolates of different serotypes was used to transform an E. coli laboratory strain. The plasmids were partially sequenced.

Results: E. coli isolates from 86 patients, mostly elderly, were shown to be positive for inhibitor-susceptible ESBLs, and more resistant to cefotaxime than to ceftazidime. Ninety-six per cent of ESBL producers were also resistant to gentamicin, and 100% to trimethoprim/sulfamethoxazole and ciprofloxacin. All isolates belonged to one of five serotypes. PFGE analysis of purified DNA yielded 17 profiles. Sequencing of plasmids isolated from the transformants identified sul1, aac(6')-Ib and blaCTX-M-2. These genes were embedded in an integron, InS21.

Conclusions: Extra-intestinal infections with ESBL-producing E. coli of different serotypes and probably mixed clonality showed a surprising homogeneity in resistance profiles, with 100% being co-resistant to ciprofloxacin and trimethoprim/sulfamethoxazole, and 96% to gentamicin. Plasmid DNA from three isolates from different serotypes contained integron InS21, previously demonstrated in Salmonella enterica from Argentina. This is the first molecular identification of an ESBL gene and integron in Israel or neighbouring geographical areas.

Keywords: extended-spectrum ß-lactamases , Enterobacteriaceae , E. coli


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