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JAC Advance Access originally published online on May 30, 2006
Journal of Antimicrobial Chemotherapy 2006 58(2):320-326; doi:10.1093/jac/dkl217
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Prevalence and mechanisms of cephalosporin resistance in Enterobacteriaceae in London and South-East England

Nicola A. C. Potz1,*, Russell Hope2, Marina Warner2, Alan P. Johnson1, David M. Livermore2 on behalf of the London & South East ESBL Project Group

1 Healthcare-Associated Infection and Antimicrobial Resistance Department, Health Protection Agency Centre for Infections 61 Colindale Avenue, London NW9 5EQ, UK 2 Antibiotic Resistance Monitoring and Reference Laboratory, Health Protection Agency Centre for Infections 61 Colindale Avenue, London NW9 5EQ, UK

Received 20 January 2006; returned 13 March 2006; revised 5 May 2006; accepted 8 May 2006

*Corresponding author. Tel: +44-208-327-7217; Fax: +44-208-205-9185; E-mail: nicola.potz{at}HPA.org.uk

Objectives: To investigate the molecular epidemiology of Enterobacteriaceae producing extended-spectrum ß-lactamases (ESBLs) in London and South-East England.

Methods: A prospective study involving 16 hospital microbiology laboratories in London and South-East England was undertaken over a 12 week period. Each laboratory submitted up to 100 consecutive cephalosporin-resistant Enterobacteriaceae isolates judged clinically significant by microbiology staff. Centralized testing was undertaken to confirm organism identification and cephalosporin resistance and to analyse resistance mechanisms.

Results: The predominant mechanism of cephalosporin resistance in isolates from both hospital and community settings was the production of CTX-M-type ESBLs, with CTX-M-producing Escherichia coli as the most numerous resistant organism overall. Other major mechanisms of cephalosporin resistance included production of non-CTX-M ESBLs and AmpC ß-lactamases. Most ESBL (both CTX-M and non-CTX-M) producers were multiply resistant to non-ß-lactam antibiotics, including trimethoprim, ciprofloxacin and gentamicin.

Conclusions: CTX-M enzymes, which were unrecorded in the UK prior to 2000, have become the major mechanism of cephalosporin resistance in Enterobacteriaceae in South-East England. E. coli has overtaken Klebsiella and Enterobacter spp. to become the major host for ESBLs. Due to the multiple antibiotic resistance exhibited by many ESBL-producers, these changes have major implications for antimicrobial therapy.

Keywords: ESBLs , CTX-M enzymes , E. coli


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