Nine carbapenem-resistant Escherichia coli isolates harboring Klebsiella pneumoniae carbapenemase (KPC)-2 or KPC-3 enzymes were identified in patients residing in 7 distinct long-term care facilities. Cefotaxime-hydrolyzing (CTX-M)-type beta-lactamases were also documented in 3 isolates. The identification of these enzymes in patients staying in long-term care facilities should be of great concern to all components of health care systems.

Quinolone-resistant Streptococcus agalactiae bacteria were recovered from single-patient isolates and found to contain mutations in the gyrase and topoisomerase IV genes. Pulsed-field gel electrophoresis demonstrated that four isolates from the same long-term care facility were closely related; in seven cases, quinolone-resistant Haemophilus influenzae and S. agalactiae bacteria were isolated from the same patient.Although disease caused by Streptococcus agalactiae (group B streptococcus [GBS]) in infants and during pregnancy is well documented, the epidemiology of patients infected with this bacterium is changing to include nonpregnant and elderly adults (1-3, 8, 14, 16). These patients often have significant underlying illness and reside in long-term care facilities (LTCFs) (5). While GBS remains fully susceptible to penicillin, antibiotic susceptibility surveys demonstrate increasing prevalences of resistance to erythromycin and clindamycin (4,8,17). Recently, quinoloneresistant GBS was detected (6). Since LTCFs can also have problems with quinolone-resistant Haemophilus influenzae (7, 9), we have looked for and found coisolation of quinoloneresistant H. influenzae with GBS from the same patients.Antimicrobial susceptibility and clinical sites of all GBS isolates processed by our clinical microbiology laboratory from 1999 to 2002 were recorded. This laboratory receives clinical specimens from patients in our hospital and from those in several affiliated LTCFs. Levofloxacin resistance in GBS was initially identified by disk diffusion methodology. The isolates were further characterized by the infectious disease research laboratory using Etest methodology (AB Biodisk, Piscataway, N.J.) and broth microdilution (STP1 and GPN Sensititre plates; Trek Diagnostic Systems, Inc., Westlake, OH) for susceptibility to erythromycin, clindamycin, ampicillin, penicillin, levofloxacin, moxifloxacin, ciprofloxacin, gatifloxacin, gemifloxacin, and garenoxacin according to manufacturers' recommendations. NCCLS susceptibility breakpoints were used for all antibiotics (10). Since only urinary isolates were routinely tested for levofloxacin susceptibility by our clinical microbiology lab-

No abstract

No abstract

No abstract

No abstract

dForty-seven extended-spectrum-␤-lactamase-positive Klebsiella pneumoniae urinary tract isolates from nonhospitalized patients were identified, and 79% harbored KPC and/or CTX-M ␤-lactamases. Approximately 90% of the isolates were resistant to trimethoprim-sulfamethoxazole and levofloxacin, and 40% were resistant to a carbapenem, while 92% were susceptible to polymyxin B, 87% were susceptible to tigecycline, and 79% were susceptible to fosfomycin. Increased use of broader-spectrum antibiotics may help to prevent their dissemination and reduce the risk of progression to invasive disease. The isolation of multidrug-resistant Gram-negative bacteria (MDRGNB) from the urinary tract has been documented in a variety of settings (1-8). While recent investigations have identified CTX-M extended-spectrum ␤-lactamases (ESBLs) in Escherichia coli, the carbapenems have remained active against such isolates (4,8,9). Although coexistent Klebsiella pneumoniae carbapenemases (KPC) and CTX-M ESBLs in E. coli urinary tract isolates from patients in long-term-care facilities (LTCFs) have been documented, few studies have been conducted to determine the extent of these enzymes in K. pneumoniae urinary tract isolates from nonhospitalized patients (3, 9). This study was performed to investigate the presence of such enzymes and describe epidemiology, clinical characteristics, and outcomes.From 1 January 2009 through 31 December 2009, 159 single patient urinary tract isolates reported as ESBL positive by the clinical microbiology laboratory using BD Phoenix NMIC/ID-123 panels (Becton Dickinson & Co., Sparks, MD) were identified. Forty-seven of the patients met the definition of "nonhospitalized" (a patient with no history of antibiotic use or hospitalization within the 30 days previous to the time when the urine specimen was obtained). Although there are many definitions of nonhospitalized patients available in the literature, gut flora can be altered after as little as 7 to 10 days into antimicrobial therapy and MDRGN can persist for up to 6 months after the completion of therapy (10, 11). Patients from LTCFs, group homes, or rehabilitation centers were excluded from the study. Specimens were collected from patients during clinic or emergency room visits. Antibiograms of isolates and patients' demographics, including age, gender, comorbid conditions, treatment, and clinical outcomes, were recorded. Readmission data were recoverable only for New York Hospital Queens (NYHQ). This study was conducted at NYHQ as a quality improvement project and did not require Institutional Review Board approval.Additional susceptibility studies were performed in the Infectious Diseases Research Laboratory using Etest methodology according to the manufacturer's specifications (AB Biodisk, Piscataway, NJ) and were interpreted according to Clinical and Laboratory Standards Institute (CLSI)-specified criteria (12). Isolates were also tested for the presence of metallo-␤-lactamases with MBL Etest strips containing imipenem with and without EDTA. The PCR metho...

No abstract