JAC Advance Access published online on November 6, 2006
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl435
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1 Centre for Infections, Health Protection Agency, London, UK
* To whom correspondence should be addressed. Objectives: To study the clonality of gentamicin-resistant, extended-spectrum Methods: Isolates were identified by API, susceptibilities were determined by local disc testing, and MICs were determined at the reference laboratory, both interpreted using BSAC guidelines. blaCTX-M genes were sought by PCR, and isolates were compared by PFGE. Results: In the years 2004 and 2005, 69 E. coli were submitted by Truro (Cornwall) laboratory for reference laboratory testing: these included 14 gentamicin-resistant, ESBL-negative isolates; 45 with group 1 CTX-M enzymes; seven with group 9 CTX-M enzymes; and three with non-CTX-M ESBLs. By PFGE, nine gentamicin-resistant, ESBL-negative E. coli were distinct (<85% similarity) from all the ESBL producers, but three were related to producers of group 1 CTX-M enzymes, and two isolates were related to a non-CTX-M ESBL producer. An outbreak strain was identified, represented by 11 gentamicin-resistant and one gentamicin-susceptible isolates, all with group 1 CTX-M enzymes, and two gentamicin-resistant, ESBL-negative isolates. This was distinct by PFGE from nationally distributed CTX-M-producing strains. Five of nine patients infected with this strain had been on the same ward in a local hospital; four presented with community-onset UTIs; one inpatient developed a hospital-acquired bacteraemia. Of the other four patients presenting with community-onset UTIs, three were admitted to different hospitals and the fourth had only attended an outpatient clinic. Conclusions: Community-onset, ESBL-producing and non-producing E. coli were diverse. Two ESBL-negative isolates were closely related to a local CTX-M-producing outbreak strain, suggesting gain or loss of a blaCTX-M-carrying plasmid. An outbreak strain was linked with prior hospital admission and appeared not to represent genuine community acquisition.
Received August 9, 2006
Revised October 2, 2006
Accepted October 3, 2006
Brief report
Molecular epidemiology of multiresistant Escherichia coli isolates from community-onset urinary tract infections in Cornwall, England
Neil Woodford 1 *, Mary E. Kaufmann 1, Edi Karisik 1, and John W. Hartley 2
2 Department of Clinical Microbiology, Royal Cornwall Hospital, Truro, UK
Neil Woodford, E-mail: neil.woodford{at}hpa.org.uk
Abstract 
-lactamase (ESBL)-negative and ESBL-producing Escherichia coli isolated from community-onset urinary tract infections (UTIs) in Cornwall.
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