-Lactam resistance was studied in 1,072 consecutive P. mirabilis clinical strains isolated at the ClermontFerrand teaching hospital between April 1996 and March 1998. The frequency of amoxicillin resistance was 48.5%. Among the 520 amoxicillin-resistant isolates, three resistance phenotypes were detected: penicillinase (407 strains [78.3%]), extended-spectrum -lactamase (74 strains [14.2%]), and inhibitor resistance (39 strains [7.5%]). The penicillinase phenotype isolates were divided into three groups according to the level of resistance to -lactams, which was shown to be related to the strength of the promoter. The characterization of the different -lactamases showed that amoxicillin resistance in P. mirabilis was almost always (97%) associated with TEM or TEM-derived -lactamases, most of which evolved via TEM-2.After Escherichia coli, Proteus mirabilis is the most often isolated member of the Enterobacteriaceae in European clinical microbiology laboratories, being isolated more often than Klebsiella pneumoniae (22,26). Wild-type strains of P. mirabilis are susceptible to all penicillins and cephalosporins. However, since 1990, the resistance of the species to -lactams has regularly increased (20,22,26,32). Amoxicillin resistance in P. mirabilis is mainly due to the plasmid-mediated penicillinases TEM-1 and TEM-2. TEM-2 is more frequently encountered in this species than in other Enterobacteriaceae (22, 28); TEM-like penicillinase TEM-57 was recently reported by Bonnet et al. (7).Since 1991, TEM-derived extended-spectrum -lactamases (ESBL) (TEM-3, TEM-8, TEM-10, TEM-21, TEM-24, TEM-26, and TEM-66) in P. mirabilis have been reported (7,11,15,24,27,29; L. Pagani, F. Luzzaro, R. Migliavacca, M. G. Perilli, R. Daturi, G. Lombardi, C. Matti, E. Giacobone, and G. Amicosante, Abstr. 37th Intersci. Conf. Antimicrob. Agents Chemother., abstr. D14, p. 85, 1997). Inhibitor-resistant TEM -lactamases (TEM-44, TEM-65, TEM-73, and TEM-74) in this species have been recently described (7, 9). Finally, non-TEM-derived -lactamases (CMY-3, CMY-4, CEP-1, CTX-M-2, and PER-2) in P. mirabilis have also been reported (4,5,6,8,36). The aim of this 2-year survey was to assess the prevalence of established and newer -lactamases among amoxicillin-resistant P. mirabilis clinical strains isolated from the teaching hospital of Clermont-Ferrand.
MATERIALS AND METHODSBacterial strains. All nonduplicate P. mirabilis strains isolated from ClermontFerrand teaching hospital during a 2-year survey (1 April 1996 to 31 March 1998) were included in this study. Isolates were identified by the Rapid ID 32 E system (BioMérieux, La Balme les Grottes, France).Susceptibility testing. Susceptibilities of P. mirabilis isolates were determined by the Rapid ATB E system (BioMérieux). A modified double-disc synergy test (11) was used to detect ESBL. The amoxicillin-resistant isolates were screened for susceptibility to a battery of -lactam antibiotics chosen to facilitate the recognition of the resistance patterns associated with the different -lac...