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JAC Advance Access originally published online on October 28, 2006
Journal of Antimicrobial Chemotherapy 2006 58(6):1260-1263; doi:10.1093/jac/dkl422
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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

Occurrence, prevalence and genetic environment of CTX-M ß-lactamases in Enterobacteriaceae from Indian hospitals

V. M. Ensor1,2, M. Shahid3, J. T. Evans1,2 and P. M. Hawkey1,2,*

1 Antimicrobial Agents Research Group, Institute of Biomedical Research, University of Birmingham Vincent Drive, Edgbaston, Birmingham B15 2TT, UK 2 West Midlands Health Protection Agency, Heart of England NHS Foundation Trust Bordesley Green East, Birmingham B9 5SS, UK 3 Department of Microbiology, Jawaharlal Nehru Medical College & Hospital (JNMCH), Aligarh Muslim University Aligarh-202002, Uttar Pradesh, India

Received 18 July 2006; returned 12 September 2006; revised 22 September 2006; accepted 25 September 2006

*Correspondence address. Health Protection Agency, Heartlands Hospital, Birmingham B9 5SS, UK. Tel: +44-121-424-1240; Fax: +44-121-772-6229; E-mail: peter.hawkey{at}heartofengland.nhs.uk

Objectives: To determine occurrence, prevalence and CTX-M genotypes produced by Enterobacteriaceae from clinical samples from three geographically distant Indian hospitals and to detect linkage of IS26 with blaCTX-M and map its precise insertion position.

Methods: A total of 130, non-duplicate Escherichia coli and Klebsiella pneumoniae resistant to a third-generation cephalosporin (3GC) from three Indian centres were screened for extended-spectrum ß-lactamase (ESBL) production using phenotypic detection methods. All isolates were screened for blaCTX-M using multiplex PCR. Precise CTX-M genotype was identified using reverse-line hybridization. All CTX-M-producing isolates were screened for linkage of IS26 with blaCTX-M. DNA sequencing was used to map the exact insertion position of this mobile element.

Results: Ninety-five of 130 3GC-resistant (73%) (73% of total E. coli, 72% of total K. pneumoniae) isolates were found to carry blaCTX-M-15. No other CTX-M genotype was detected. IS26 linkage with blaCTX-M-15 was detected in 31% of isolates carrying blaCTX-M-15. DNA sequencing revealed variable insertion of this mobile element within tnpA of ISEcp1. RAPD–PCR typing demonstrated great diversity in isolates carrying blaCTX-M-15; no predominant clone was identified.

Conclusions: In contrast with other studies where greater diversity exists, CTX-M-15 was the only CTX-M ESBL produced in this Indian collection of unrelated E. coli and K. pneumoniae. This is the first systematic survey report from India detecting CTX-M-type ß-lactamases This is also the first report indicating such high mobility/diversity of insertion of IS26 in close association with blaCTX-M in a single bacterial collection.

Keywords: ESBLs , IS26 , CTX-M-15 , India


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