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JAC Advance Access originally published online on January 28, 2005
Journal of Antimicrobial Chemotherapy 2005 55(3):326-332; doi:10.1093/jac/dki010
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JAC vol.55 no.3 © The British Society for Antimicrobial Chemotherapy 2005; all rights reserved

Detection and characterization of extended-spectrum ß-lactamases among bloodstream isolates of Enterobacter spp. in Hong Kong, 2000–2002

P. L. Ho1,*, Ricky H. L. Shek2, K. H. Chow1, R. S. Duan1, Gannon C. Mak1, Eileen L. Lai1, W. C. Yam1, Kenneth W. Tsang3 and W. M. Lai2

1 Division of Infectious Diseases, Department of Microbiology and Centre of Infection and 2 Department of Clinical Pathology, United Christian Hospital; 3 Department of Medicine, Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China

* Correspondence address. Division of Infectious Diseases, Department of Microbiology and Centre of Infection, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Pokfulam, Hong Kong SAR, China. Tel: +852-2855-4897; Fax: +852-2855-1241; Email: plho{at}hkucc.hku.hk

Objectives: A total of 139 consecutive and non-duplicate bloodstream isolates of Enterobacter spp. collected from inpatients in Hong Kong during 2000–2002 were studied for production of extended-spectrum ß-lactamases (ESBLs).

Methods: All isolates were evaluated by the modified double-disc synergy test (m-DDST), the combined disc method (CDM) and the three-dimensional (3D) test. The m-DDST and CDM were modified by the use of cefepime discs. ß-Lactamases were characterized by isoelectric focusing and PCR sequencing using specific primers.

Results: ESBLs were identified in nine isolates (overall 6.5%), including seven of 39 (17.9%) Enterobacter hormaechei, one of 27 (3.7%) Enterobacter aerogenes and the only Enterobacter intermedius strain. The E. intermedius strain was positive only in the 3D test but not in the other two tests. The other eight strains were positive in all three tests. No ESBL was detected in the other species, including non-hormaechei members of the Enterobacter cloacae complex (n=61), Enterobacter agglomerans (n=7), Enterobacter gergoviae (n=4) and Enterobacter sakazakii (n=1). The ESBL content included five different CTX-M enzymes (CTX-M-9, CTX-M-13, CTX-M-14, CTX-M-24 and a novel CTX-M-2-like ß-lactamase), SHV-12 (n=2) and unidentifiable ESBLs with a pI of 7.7 or 7.9 in two strains. The seven ESBL-producing E. hormaechei were genotyped by pulsed-field gel electrophoresis and were found to be unrelated to each other. In three of the CTX-M-producing strains, ISEcp1-like elements, including promoters for the ß-lactamase gene, were found.

Conclusions: Our data underscore the diversity of CTX-M enzymes among Enterobacter spp. in Hong Kong.

Keywords: cephalosporin resistance , ESBLs , CTX-M enzymes


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