Prevalence of extended spectrum β-lactamase producing escherichia coli and klebsiella isolates in a large community teaching hospital in connecticut

Dandekar, Prachi K.; Tetreault, Janice; Quinn, John P.; Nightingale, Charles H.; Nicolau, David P.

doi:10.1016/j.diagmicrobio.2003.11.009

Cited by 9 publications

(12 citation statements)

References 4 publications

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“…include an initial screening with either CPD, CTX, CAZ, ceftriaxone, or aztreonam, followed by a confirmation test using both CTX and CAZ in combination with clavulanate (30). A practice exists among some clinical laboratories of using CAZ as the initial screening drug and CAZ with CLA as the confirmation test (10,16). Data from this study indicate that 14% of ESBL-producing strains will not be detected if CAZ is used as the initial screen.…”

Section: Discussionmentioning

confidence: 88%

Phenotypic and Molecular Detection of CTX-M-β-Lactamases Produced by Escherichia coli and Klebsiella spp

2004

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Organisms producing CTX-M-␤-lactamases are emerging around the world as a source of resistance to oxyiminocephalosporins such as cefotaxime (CTX). However, the laboratory detection of these strains is not well defined. In this study, a molecular detection assay for the identification of CTX-M-␤-lactamase genes was developed and used to investigate the prevalence of these enzymes among clinical isolates of Escherichia coli and Klebsiella species in the Calgary Health Region during 2000 to 2002. In addition, National Committee for Clinical Laboratory Standards (NCCLS) recommendations were evaluated for the ability to detect isolates with CTX-M extended-spectrum ␤-lactamases (ESBLs). The PCR assay consisted of four primer sets and demonstrated 100% specificity and sensitivity for detecting different groups of CTX-M-␤-lactamases in control strains producing well-characterized ESBLs. Using these primer sets, 175 clinical strains producing ESBLs were examined for the presence of CTX-M enzymes; 24 (14%) were positive for bla CTX-M-1-like genes, 95 (54%) were positive for bla CTX-M-14-like genes, and the remaining 56 (32%) were negative for bla CTX-M genes. Following the NCCLS recommendations for ESBL testing, all of the control and clinical strains were detected when screened with cefpodoxime and when both cefotaxime and ceftazidime with clavulanate were used as confirmation tests.Resistance to the expanded-spectrum cephalosporins can occur in Escherichia coli and Klebsiella species via the production of extended-spectrum ␤-lactamases (ESBLs) that are capable of hydrolyzing the oxyiminocephalosporins and monobactams (11). Recently, a family of ESBLs which preferentially hydrolyze cefotaxime (CTX), the CTX-M-␤-lactamases, have been recognized and reported in the literature with increasing frequency (3). This resistance mechanism is widespread throughout the world, with reports of clinical isolates producing these ␤-lactamases from Europe, Africa, Asia, South America, and most recently North America (3, 27).CTX-M-␤-lactamases are not closely related to TEM or SHV ESBLs (7) but share high amino acid identity with chromosomal ␤-lactamases from Kluyvera georgiana (34), Kluyvera cryocrescens (17) and Kluyvera ascorbata (24). In fact, the CTX-M-5 enzyme is identical to the chromosomal gene of K. ascorbata (3). According to a recent review and new data within GenBank, CTX-M-␤-lactamases can be divided into five groups based on their amino acid sequence identities (3). Group I includes CTX-M-1, -3, -10 to -12, -15 (UOE-1), -22, -23, -28, -29, and -30. Group II includes CTX-M-2, -4 to -7, and -20 and Toho-1. Group III includes CTX-M-8. Group IV includes CTX-M-9, -13, -14, -16 to -19, -21, and -27 and Toho-2. Finally group V includes CTX-M-25 and -26. The members of these groups exhibit Ͼ94% amino acid identity within the group and Յ90% amino acid identity between groups (3).The laboratory detection of organisms producing CTX-M-␤-lactamases is not well defined. The guidelines published by the National Committee for Clinical Labor...

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Section: Discussionmentioning

confidence: 88%

Phenotypic and Molecular Detection of CTX-M-β-Lactamases Produced by Escherichia coli and Klebsiella spp

2004

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“…The prevalence of ESBL-producing enterobacterial isolates evaluated in the present study (29%) is much higher than that described in several other parts of the world. In the USA, the prevalence of ESBL-producing enterobacterial isolates is usually less than 9% for K. pneumoniae and less than 4% for E. coli (Jones and Pfaller, 1998;Dandekar et al, 2004). In Europe, the prevalence is around 15%-20% (Babini et al, 2000;Fluit et al, 2000;Luzzaro et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of AmpC and other β-lactamases in enterobacteria at a large urban university hospital in Brazil

Dias

Borges-Neto

Ferraiuoli

et al. 2008

Diagnostic Microbiology and Infectious Disease

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Production of extended-spectrum beta-lactamases (ESBLs) has been reported in virtually all species of Enterobacteriaceae, which greatly complicates the therapy for infections caused by these organisms. However, the frequency of isolates producing AmpC beta-lactamases, especially plasmid-mediated AmpC (pAmpC), is largely unknown. These beta-lactamases confer resistance to extended-spectrum cephalosporins and aztreonam, a multidrug-resistant (MDR) profile. The aim of the present study was to determine the occurrence of ESBL and pAmpC beta-lactamases in a hospital where MDR enterobacterial isolates recently emerged. A total of 123 consecutive enterobacterial isolates obtained from 112 patients at a university hospital in Rio de Janeiro, Brazil, during March to June 2001 were included in the study. ESBL was detected by the addition of clavulanate to cephalosporin containing disks and by double diffusion. AmpC production was evaluated by a modified tridimensional test and a modified Hodge test. The presence of plasmid-mediated ampC beta-lactamase genes was evaluated by multiplex polymerase chain reaction. Sixty-five (53%) of 123 enterobacterial isolates were MDR obtained from 56 patients. ESBL production was detected in 35 isolates; 5 clonal Escherichia coli isolates exhibited high levels of chromosomal AmpC and ESBL production. However, no isolates contained pAmpC genes. Infection or colonization by MDR enterobacteria was not associated with any predominant resistant clones. A large proportion of hospital infections caused by ESBL-producing enterobacteria identified during the study period were due to sporadic infections rather than undetected outbreaks. This observation emphasizes the need to improve our detection methods for ESBL- and AmpC-producing organisms in hospitals where extended-spectrum cephalosporins are in wide use.

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“…Previous experiments demonstrated that the ESBL producing isolates at our institution were clonally distinct and that 83% of isolates produced multiple enzymes. 16 Pharmacokinetic/pharmacodynamic analysis A published two-compartment population pharmacokinetic model was used to predict cefepime exposure. 17 Cefepime clearance (CL) was estimated by using the equation CL Z 0.329 liter/h þ (0.0551 Â CL CR ).…”

Section: Patient Selectionmentioning

confidence: 99%

Cefepime pharmacodynamics in patients with extended spectrum β-lactamase (ESBL) and non-ESBL infections

Lee

Kuti

Nicolau

2007

Journal of Infection

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Prevalence of extended spectrum β-lactamase producing escherichia coli and klebsiella isolates in a large community teaching hospital in connecticut

Cited by 9 publications

References 4 publications

Phenotypic and Molecular Detection of CTX-M-β-Lactamases Produced by Escherichia coli and Klebsiella spp

Phenotypic and Molecular Detection of CTX-M-β-Lactamases Produced by Escherichia coli and Klebsiella spp

Prevalence of AmpC and other β-lactamases in enterobacteria at a large urban university hospital in Brazil

Cefepime pharmacodynamics in patients with extended spectrum β-lactamase (ESBL) and non-ESBL infections

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