Regional outbreak of CTX-M-2 β-lactamase-producing Proteus mirabilis in Japan

Abstract

Proteus mirabilis is a common cause of urinary tract infection. Wild-type P. mirabilis strains are usually susceptible to penicillins and cephalosporins, but occurrences of P. mirabilis producing extended-spectrum b-lactamases (ESBLs) have been recently reported. Here, we surveyed the prevalence of cefotaxime resistance among P. mirabilis strains at seven different hospitals in Kanagawa Prefecture, Japan, and investigated their molecular epidemiology to explain the mechanism of their spread. The prevalence of cefotaxime resistance among P. mirabilis increased annually, from 10.1 % in 1998 to 23.1 % in 2003, and increased drastically in 2004, exceeding 40 %. We collected 105 consecutive and non-duplicate cefotaxime-resistant P. mirabilis isolates (MIC 16 to .256 mg ml "1 ) from these hospitals from June 2004 to May 2005 and characterized their profile. PCR and sequence analysis revealed that all resistant strains produced exclusively CTX-M-2 b-lactamase. PFGE analysis identified 47 banding patterns with 83 % or greater similarity. These results indicated that a regional outbreak of P. mirabilis producing CTX-M-2 blactamase has occurred in Japan and suggest that the epidemic spread occurred within and across hospitals and communities by extended clonal strains. Plasmid analysis revealed that 44.8 % of plasmids harboured by bla CTX-M-2 isolates had common profiles, encoding ISEcp1, IS26 and Int1, and belonged to incompatibility group T. Spread of the resistant isolates in Japan resulted from dissemination of narrow-host-range plasmids of the IncT group encoding bla CTX-M-2 . These findings indicate the rapidly developing problem of treating the species to prevent dissemination of ESBL producers.

Broad Spectrum Microbicidal Activity of Photocatalysis by TiO2

“…These infectious diseases are a threat to human health, and indeed, outbreaks and serious clinical cases have occurred [17]. Effective disinfection of healthcare equipment and surfaces is critical for preventing transmission of potential pathogens [18].…”

Characterization of a Novel IncHI2 Plasmid Carrying Tandem Copies of bla CTX-M-2 in a fosA6 -Harboring Escherichia coli Sequence Type 410 Strain

“…CTX-M-2 was identified in Argentina in 1989, first in different Salmonella serovars and then in diverse species of Enterobacteriaceae (1). Although it is not observed as frequently as CTX-M-1-and CTX-M-9-group enzymes, CTX-M-2 is endemic in South America (1,6), caused a regional outbreak in Japan (7), circulates in animal and human strains in some European countries (8), and has been reported in North America (4,5). In South America and Europe, bla CTX-M-2 is associated mainly with complex sul1-type integrons containing ISCR1 (9,10), while in Japan most cases are associated with ISEcp1 (7,11).…”

“…In South America and Europe, bla CTX-M-2 is associated mainly with complex sul1-type integrons containing ISCR1 (9,10), while in Japan most cases are associated with ISEcp1 (7,11). Only a few studies have examined the incompatibility (Inc) types of the plasmids carrying bla CTX-M-2 (7,8,11,12). In a survey of human and poultry isolates from Europe, bla CTX-M genes were found to be associated with IncHI2-type plasmids, and all bla CTX-M-2 -carrying plasmids belonged to the IncHI2 APEC-O1-R type (8,13,14).…”

“…Although it is not observed as frequently as CTX-M-1-and CTX-M-9-group enzymes, CTX-M-2 is endemic in South America (1,6), caused a regional outbreak in Japan (7), circulates in animal and human strains in some European countries (8), and has been reported in North America (4,5). In South America and Europe, bla CTX-M-2 is associated mainly with complex sul1-type integrons containing ISCR1 (9,10), while in Japan most cases are associated with ISEcp1 (7,11). Only a few studies have examined the incompatibility (Inc) types of the plasmids carrying bla CTX-M-2 (7,8,11,12).…”

Fecal Carriage of ESBL types TEM, SHV, CTX Producing Genera Proteus, Morganella, Providencia in Patients of Iran

“…These organisms are one of the main causes of infections such as UTI (urinary tract infection), respiratory tract, wounds, bacteremia and other opportunistic infections and perhaps act as infection sources for extended-spectrum beta-lactamases (ES Ls) productions in both society and hospitals. Some studies have shown that the ES L and AmpC producing isolates of can be a cause of clonal spread in the hospital, regional and continent-wide outbreak (Nakano, 2012).…”