JAC Advance Access originally published online on September 3, 2004
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Journal of Antimicrobial Chemotherapy 2004 54(4):735-743; doi:10.1093/jac/dkh424
JAC vol.54 no.4 © The British Society for Antimicrobial Chemotherapy 2004; all rights reserved
Community and hospital spread of Escherichia coli producing CTX-M extended-spectrum ß-lactamases in the UK
1 Antibiotic Resistance Monitoring and Reference Laboratory, 2 Laboratory of HealthCare-Associated Infections, and 3 Laboratory of Enteric Pathogens, Specialist and Reference Microbiology Division–Colindale, Health Protection Agency, London; 4 Communicable Disease Surveillance Centre, Health Protection Agency, London; 5 Local and Regional Services, Health Protection Agency, London; 6 Kingston Hospital NHS Trust, Kingston, Surrey; 7 Belfast City Hospital, Belfast; 8 HPA South-East, Southampton Laboratory, Southampton; 9 Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
* Correspondence address. ARMRL, SRMD–Colindale, Health Protection Agency, 61 Colindale Ave., London NW9 5HT, UK. Tel: +44-(0)20-8327-7255; Fax: +44-(0)20-8327-6264; Email: neil.woodford{at}hpa.org.uk
Objectives: During 2003, the Health Protection Agency's Antibiotic Resistance Monitoring and Reference Laboratory began to receive isolates of Escherichia coli for confirmation of extended-spectrum ß-lactamase production with a phenotype implying a CTX-M-type ß-lactamase, i.e. MICs of cefotaxime 
8-fold higher than MICs of ceftazidime. Many were referred as being from community patients. We examined 291 CTX-M-producing isolates from the UK and investigated the genetic basis of their phenotype.
Methods: PCR was used to detect alleles encoding CTX-M enzymes and to assign these to their blaCTX-M phylogenetic groups. Selected alleles were sequenced. Producers were compared by analysis of banding patterns generated by pulsed-field gel electrophoresis of XbaI-digested genomic DNA. MICs were determined by an agar dilution method or by Etest.
Results: Of 291 CTX-M-producing E. coli isolates studied from 42 UK centres, 70 (24%) were reportedly from community patients, many of whom had only limited recent hospital contact. Community isolates were referred by 12 centres. Two hundred and seventy-nine (95.9%) producers contained genes encoding group 1 CTX-M enzymes and 12 contained blaCTX-M-9-like alleles. An epidemic CTX-M-15-producing strain was identified, with 110 community and inpatient isolates referred from six centres. Representatives of four other major strains also produced CTX-M-15, as did several sporadic isolates examined. Most producers were multi-resistant to fluoroquinolones, trimethoprim, tetracycline and aminoglycosides as well as to non-carbapenem ß-lactams.
Conclusions: CTX-M-producing E. coli are a rapidly developing problem in the UK, with CTX-M-15 particularly common. The diversity of producers and geographical scatter of referring laboratories indicates wide dissemination of blaCTX-M genes. Because of the public health implications, including for the treatment of community-acquired urinary tract infections, the spread of these strains—and CTX-M-15 ß-lactamase in particular—merits close monitoring.
Keywords: ESBLs , CTX-M ß-lactamases , community infections , molecular epidemiology
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H. Rodriguez-Villalobos, V. Malaviolle, J. Frankard, R. d. Mendonca, C. Nonhoff, and M. J. Struelens In vitro activity of temocillin against extended spectrum {beta}-lactamase-producing Escherichia coli J. Antimicrob. Chemother., April 1, 2006; 57(4): 771 - 774. [Abstract] [Full Text] [PDF]
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A. Eisner, E. J. Fagan, G. Feierl, H. H. Kessler, E. Marth, D. M. Livermore, and N. Woodford Emergence of Enterobacteriaceae Isolates Producing CTX-M Extended-Spectrum {beta}-Lactamase in Austria Antimicrob. Agents Chemother., February 1, 2006; 50(2): 785 - 787. [Abstract] [Full Text] [PDF]
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C. Eckert, V. Gautier, and G. Arlet DNA sequence analysis of the genetic environment of various blaCTX-M genes J. Antimicrob. Chemother., January 1, 2006; 57(1): 14 - 23. [Abstract] [Full Text] [PDF]
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O. O. Soge, A. M. Queenan, K. K. Ojo, B. A. Adeniyi, and M. C. Roberts CTX-M-15 extended-spectrum {beta}-lactamase from Nigerian Klebsiella pneumoniae J. Antimicrob. Chemother., January 1, 2006; 57(1): 24 - 30. [Abstract] [Full Text] [PDF]
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N. Woodford, E. J. Fagan, and M. J. Ellington Multiplex PCR for rapid detection of genes encoding CTX-M extended-spectrum {beta}-lactamases J. Antimicrob. Chemother., January 1, 2006; 57(1): 154 - 155. [Full Text] [PDF]
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 S. Damoa-Siakwan Extended-spectrum beta lactamases: an overview Journal of Infection Prevention, December 1, 2005; 6(6): 25 - 28. [Abstract] [PDF]
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E. Miro, B. Mirelis, F. Navarro, A. Rivera, R. J. Mesa, M. C. Roig, L. Gomez, and P. Coll Surveillance of extended-spectrum {beta}-lactamases from clinical samples and faecal carriers in Barcelona, Spain J. Antimicrob. Chemother., December 1, 2005; 56(6): 1152 - 1155. [Abstract] [Full Text] [PDF]
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L. Xu, V. Ensor, S. Gossain, K. Nye, and P. Hawkey Rapid and simple detection of blaCTX-M genes by multiplex PCR assay J. Med. Microbiol., December 1, 2005; 54(12): 1183 - 1187. [Abstract] [Full Text] [PDF]
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J. D. D. Pitout, K. B. Laupland, D. L. Church, M. L. Menard, and J. R. Johnson Virulence Factors of Escherichia coli Isolates That Produce CTX-M-Type Extended-Spectrum {beta}-Lactamases Antimicrob. Agents Chemother., November 1, 2005; 49(11): 4667 - 4670. [Abstract] [Full Text] [PDF]
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D. H. Wyllie, E. Baxter, M. Morgan, and I. C. J. W. Bowler Spread of multiresistance and extended-spectrum {beta}-lactamases amongst urinary Escherichia coli in Oxford, UK J. Antimicrob. Chemother., November 1, 2005; 56(5): 986 - 988. [Full Text] [PDF]
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 D. L. Paterson and R. A. Bonomo Extended-Spectrum {beta}-Lactamases: a Clinical Update Clin. Microbiol. Rev., October 1, 2005; 18(4): 657 - 686. [Abstract] [Full Text] [PDF]
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C. Arpin, V. Dubois, J. Maugein, J. Jullin, B. Dutilh, J.-P. Brochet, G. Larribet, I. Fischer, and C. Quentin Clinical and Molecular Analysis of Extended-Spectrum {beta}-Lactamase-Producing Enterobacteria in the Community Setting J. Clin. Microbiol., October 1, 2005; 43(10): 5048 - 5054. [Abstract] [Full Text] [PDF]
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D. M. Livermore Tigecycline: what is it, and where should it be used? J. Antimicrob. Chemother., October 1, 2005; 56(4): 611 - 614. [Abstract] [Full Text] [PDF]
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D. M. Livermore and P. M. Hawkey CTX-M: changing the face of ESBLs in the UK J. Antimicrob. Chemother., September 1, 2005; 56(3): 451 - 454. [Abstract] [Full Text] [PDF]
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T. Naas, A. Lezzar, C. Bentchouala, F. Smati, J.-M. Scheftel, H. Monteil, and P. Nordmann Multidrug-resistant Salmonella enterica serotype Senftenberg isolates producing CTX-M {beta}-lactamases from Constantine, Algeria J. Antimicrob. Chemother., August 1, 2005; 56(2): 439 - 440. [Full Text] [PDF]
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T. G. Winstanley, H. K. Parsons, M. A. Horstkotte, I. Sobottka, and E. Sturenburg Phenotypic detection of {beta}-lactamase-mediated resistance to oxyimino-cephalosporins in Enterobacteriaceae: evaluation of the Mastascan Elite Expert System J. Antimicrob. Chemother., August 1, 2005; 56(2): 292 - 296. [Abstract] [Full Text] [PDF]
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L. Politi, P. T. Tassios, M. Lambiri, A. Kansouzidou, M. Pasiotou, A. C. Vatopoulos, K. Mellou, N. J. Legakis, and L. S. Tzouvelekis Repeated Occurrence of Diverse Extended-Spectrum {beta}-Lactamases in Minor Serotypes of Food-Borne Salmonella enterica subsp. enterica J. Clin. Microbiol., July 1, 2005; 43(7): 3453 - 3456. [Abstract] [Full Text] [PDF]
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J. D. D. Pitout, P. Nordmann, K. B. Laupland, and L. Poirel Emergence of Enterobacteriaceae producing extended-spectrum {beta}-lactamases (ESBLs) in the community J. Antimicrob. Chemother., July 1, 2005; 56(1): 52 - 59. [Abstract] [Full Text] [PDF]
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J. D. D. Pitout, D. B. Gregson, D. L. Church, S. Elsayed, and K. B. Laupland Community-Wide Outbreaks of Clonally Related CTX-M-14 {beta}-Lactamase-Producing Escherichia coli Strains in the Calgary Health Region J. Clin. Microbiol., June 1, 2005; 43(6): 2844 - 2849. [Abstract] [Full Text] [PDF]
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D. M. Livermore, S. Mushtaq, and M. Warner Selectivity of ertapenem for Pseudomonas aeruginosa mutants cross-resistant to other carbapenems J. Antimicrob. Chemother., March 1, 2005; 55(3): 306 - 311. [Abstract] [Full Text] [PDF]
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 G. A. Jacoby and L. S. Munoz-Price The New {beta}-Lactamases N. Engl. J. Med., January 27, 2005; 352(4): 380 - 391. [Full Text] [PDF]
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