Occurrence of Extended-Spectrum Betalactamases (ESBL) in Dutch Hospitals

Stobberingh, Ellen E.; Arends, Jp; Hoogkamp-Korstanje, J.A.A.; Goessens, W. H. F.; Visser, Maaike; Buiting, A. G. M.; Debets-Ossenkopp, Yvette J.; Ketel, R J van; Ogtrop, M L van; Sabbe, L.; Voorn, G. Paul; Winter, H L J; Zeijl, J.H. van

doi:10.1007/s150100050041

Cited by 41 publications

(25 citation statements)

References 23 publications

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“…A total of 19.8% of the strains produced ESBLs. The prevalence of ESBL-producing strains in Korea was much higher than that in The Netherlands, where approximately 2% of isolates produced ESBLs (24). The clinical significance of these isolates, which were widespread in Korea, is of great importance, as clinicians are advised against the use of extended-spectrum cephalosporins, aztreonam, and cephamycins.…”

Section: Resultsmentioning

confidence: 99%

Molecular Characterization of Extended-Spectrum Beta-Lactamases Produced by Clinical Isolates of Klebsiella pneumoniae and Escherichia coli from a Korean Nationwide Survey

et al. 2004

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To determine the prevalence and genotypes of extended-spectrum beta-lactamases (ESBLs) among clinical isolates of Klebsiella pneumoniae and Escherichia coli, we performed antibiotic susceptibility testing, pI determination, induction testing, transconjugation, and DNA sequencing analysis. Among the 509 isolates collected from 13 university hospitals in Korea, 39.2% produced ESBLs. ESBL-producing isolates were detected in every region in Korea. A total of 44.6% of the isolates produced both TEM-and SHV-type ESBLs, and 52% of ESBL-producing isolates transferred resistance to ceftazidime by transconjugation. The ESBLs were TEM-19, TEM-20, TEM-52, SHV-2a, SHV-12, and one new variant identified for the first time in Korea, namely, TEM-116. TEM-1 and SHV-12 were by far the most common variants. TEM-1, TEM-116, and SHV-12 showed a high prevalence in K. pneumoniae. Two isolates (E. coli SH16 and K. pneumoniae SV3) produced CMY-1-like beta-lactamases, which play a decisive role in resistance to cefoxitin and cefotetan, as well as TEM-type enzymes (TEM-20 and TEM-52, respectively). Using MIC patterns and DNA sequencing analysis, we postulated a possible evolution scheme among TEM-type beta-lactamases in Korea: from TEM-1 to TEM-19, from TEM-19 to TEM-20, and from TEM-20 to TEM-52.

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Section: Resultsmentioning

confidence: 99%

Molecular Characterization of Extended-Spectrum Beta-Lactamases Produced by Clinical Isolates of Klebsiella pneumoniae and Escherichia coli from a Korean Nationwide Survey

et al. 2004

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“…The prevalence of ESBL-producing E. coli and Klebsiella spp. isolates in Dutch hospitals was less than 1% in 1997 (17).…”

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confidence: 93%

“…The previous survey was performed in eight university hospitals, including the Academic Medical Center (AMC) which participated in the current study, and three large regional laboratories and showed that the prevalence of ESBL among isolates of E. coli and Klebsiella spp. was Ͻ1% (17). During the 1997 study, no ESBLs were found in the AMC.…”

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confidence: 95%

Widely Distributed and Predominant CTX-M Extended-Spectrum β-Lactamases in Amsterdam, The Netherlands

et al. 2006

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“…In The Netherlands the incidence of extended-spectrum ␤-lactamase (ESBL)-producing bacteria is low (22). Outbreaks appear to be rare in The Netherlands, especially in general acute-care hospitals.…”

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confidence: 99%

Patterns of Resistance Associated with Integrons, the Extended-Spectrum β-Lactamase SHV-5 Gene, and a Multidrug Efflux Pump of Klebsiella pneumoniae Causing a Nosocomial Outbreak

Gruteke¹,

Goessens

Gils³

et al. 2003

J Clin Microbiol

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Multiresistant Klebsiella pneumoniae caused a nosocomial outbreak. Resistance patterns of the presumed outbreak isolates varied among and within patients. In order to control the outbreak, screening for extendedspectrum ␤-lactamase (ESBL)-producing K. pneumoniae was commenced. A number of susceptible K. pneumoniae strains were stored to serve as controls in genetic strain typing. Typing by pulsed-field gel electrophoresis proved the clonality of the strains in the recognized outbreak patients. Typing of the control strains by pulsed-field gel electrophoresis showed that at least one patient had been missed by the ESBL screening procedure. Further genetic typing confirmed the presence of the SHV-5 ESBL gene in all but one of the outbreak strains. Variable presence of integrons that carried the aminoglycoside resistance genes aadB and aadA2 was found. A gyrA mutation in codon 83 was present in all outbreak strains tested, despite considerable differences in ciprofloxacin MICs. The MICs of ciprofloxacin and the chemically unrelated drug cefoxitin were correlated (r ‫؍‬ 0.86, P < 0.01) and were compatible with the overexpression of an efflux pump in a subset of the outbreak strains. We conclude that outbreak strains that express an ESBL gene only at a low level may pass unnoticed in a screening procedure, when the laboratory is unaware of variable ESBL expression. In this particular outbreak, screening for strains for which ciprofloxacin MICs were >0.25 g/ml would in retrospect have been the most sensitive method for detection of the K. pneumoniae outbreak strain.Nosocomial outbreaks in reference centers due to multiresistant Klebsiella pneumoniae isolates have been described frequently (6,19,21). In The Netherlands the incidence of extended-spectrum ␤-lactamase (ESBL)-producing bacteria is low (22). Outbreaks appear to be rare in The Netherlands, especially in general acute-care hospitals. Many factors need to be addressed simultaneously in bringing an outbreak under control: appropriate isolation measures need to be taken, hand hygiene procedures may need reinforcement, possible environmental reservoirs need elimination, and antibiotics policies may need reconsideration. Screening in search of colonized patients needs to be instituted, and decisions on how to perform such screening have to be made (10). The aim of this study was to elucidate resistance mechanisms in the outbreak strain that are relevant to the description of the observed course of the outbreak. This was done in order to retrospectively evaluate the appropriateness of the decisions made at the beginning of the outbreak.(Part of this work was presented at the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, Ill., 2001.) MATERIALS AND METHODSHospital and patients. The Zuiderzee Hospital Lelystad is a 250-bed facility providing care for a population of 70,000. The Intensive Care Unit/Coronary Care Unit (ICU) has eight beds and is able to care for three ventilated patients. The general surgical nursing ward has two units ...

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Occurrence of Extended-Spectrum Betalactamases (ESBL) in Dutch Hospitals

Cited by 41 publications

References 23 publications

Molecular Characterization of Extended-Spectrum Beta-Lactamases Produced by Clinical Isolates of Klebsiella pneumoniae and Escherichia coli from a Korean Nationwide Survey

Molecular Characterization of Extended-Spectrum Beta-Lactamases Produced by Clinical Isolates of Klebsiella pneumoniae and Escherichia coli from a Korean Nationwide Survey

Widely Distributed and Predominant CTX-M Extended-Spectrum β-Lactamases in Amsterdam, The Netherlands

Patterns of Resistance Associated with Integrons, the Extended-Spectrum β-Lactamase SHV-5 Gene, and a Multidrug Efflux Pump of Klebsiella pneumoniae Causing a Nosocomial Outbreak

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