Prevalence of Extended Spectrum $\beta-Lactamase-Producing$ Clinical Isolates of Escher­ichia coli in a University Hospital, Korea

국내 대학병원에서 분리된 Eschepichia coli의 Extended-spectrum $\beta-Lactamase$ (ESBL) 현황

  • Lee Kyenam (Department of Biology and Culture Collection of Antimicrobial Resistant Microbes, Seoul Women's University) ;
  • Kim Woo-Joo (Department of Infectious Diseases, Kuro Hospital, Korea University) ;
  • Lee Yeonhee (Department of Biology and Culture Collection of Antimicrobial Resistant Microbes, Seoul Women's University)
  • 이계남 (서울여자대학교 생물학과 항생제내성균주은행) ;
  • 김우주 (고려대학교 의과대학 감염내과) ;
  • 이연희 (서울여자대학교 생물학과 항생제내성균주은행)
  • Published : 2004.12.01

Abstract

Recently, the rapid increase and global spread of extended-spectrum $\beta-lactamase$ producing clinical isolates has become a serious problem. The incidence of extended-spectrum $\beta-lactamase$ producing clinical isolates of Escherichia coli in Korea and susceptibility to antimicrobial agents were investigated. Total 233 isolates of E. coli were obtained from urine from hospitalized patients in Guro hospital, Korea University in 2001. One hun­dred and eighty four isolates $(78.9\%)$ were resistant to ampicillin, 80 isolates $(34.3\%)$ were resistant to ceph­alothin, 93 isolates $(39.9\%)$ were resistant to gentamicin, and 64 isolates $(27.5\%)$ were resistant to norfloxacin. Among 233 isolates, 17 isolates $(7.3\%)$ were positive as determined by the double disk synergy test. When min­imal inhibitory concentrations were assayed with additional 6 antimicrobial agents, 13 isolates $(76.5\%)$ were multi-drug resistant to at least four different class antimicrobial agents. Extended-spectrum $\beta-lactamase$ were characterized with isoelectric focusing gel electrophoresis and DNA sequencing. They were TEM-1 in 5 iso­lates, TEM-15 in 1 isolate, TEM-20 in 1 isolate, TEM-52 in 4 isolates, TEM-1 and AmpC in 2 isolates, TEM-1 and OXA-30 in 1 isolate, TEM-1 and OXA-33 in 1 isolate, TEM-1, CTX-M-3, and AmpC in 1 isolate, but SHV was not detected. Antimicrobial resistance genes were transferred to animal isolate of E. coli (CCARM No. 1203) by the filter mating method. Extended spectrum $\beta-lactamase$ producers studied in the current study have low correlation to each other as determined by random amplified polymorphic DNA and pulsed field gel elec­trophoresis. This is a contradictory result from the general hypothesis that extended-spectrum $\beta-lactamase$ pro­ducers in one hospital is a result from a clonal spread.

Keywords

antimicrobial resistance;TEM;OXA;CTX-M;Escherichia coli

References

  1. Bush, K., G.A. Jacoby, and A.A. Medeiros. 1995. A functional classification scheme for $\beta$-lactamases and its correlation with molecular structures. Antimicrob. Agents Chemother. 39, 1211- 1233
  2. Emery, C.L. and L.A. Weymouth. 1997. Detection and clinical significance of extended-spectrum $\beta$-lactamases in a tertiary-care medical center. J. Clin. Microbiol. 35, 2061-2067
  3. Jeong, S. H., I. K. Bae, S. G. Sohn, G. H. Kang, G. J. Jeon, Y. H. Kim, B. C. Jeong, and S. H. Lee. 2004. Molecular characterization of extended-spectrum beta-lactamases produced by clinical isolates of Klebsiella pneumoniae and Escherichia coli from a Korean nationwide survey. J Clin. Microbiol. 42, 2902-2906
  4. Kim, Y.K., H. Pai, H.J. Lee, S.E. Park, E.H. Choi, J. Kim, J.H. Kim, and E.C. Kim. 2002. Bloodstream infections by extended-spectrum $\beta$-lactamases-producing Escherichia coli and Klebsiella pneumoniae in children: epidemiology and clinical outcome. Antimicrob. Agents Chemother. 46, 1481-1491
  5. Philippon, A., G. Arlet, and G.A. Jacoby. 2002. Plasmid-determined AmpC-type $\beta$-lactamases. Antimicrob. Agents Chemother. 46, 1- 11
  6. Siu, L.K., P.L. Lu, J.Y. Chen, F.M. Lin, and S.C. Chang. 2003. High-level expression of AmpC $\beta$-lactamase due to insertion of nucleotides between -10 and -35 promoter sequences in Escherichia coli clinical isolates: Cases not responsive to extended-spectrum -cephalosporin treatment. Antimicrob. Agents Chemother. 47, 2138-2144
  7. Spanu, T., F. Luzzaro, M. Perilli, G. Amicosante, A. Toniolo, G. Fadda, and The Italian ESBL study group. 2002. Occurrence of extended-spectrum $\beta$-lctamases in members of the family Enterobacteriaceae in Italy: Implications for resistance to $\beta$-lactamase and other antimicrobial drugs. Antimicrob. Agents Chemother. 46, 196-202
  8. Yan, J.J., W.C. Ko, S.H. Tsai, H.M. Wu, Y.T. Jin, and J.J. Wu. 2000. Dissemination of CTX-M-3 and CMY-2 $\beta$-lactamases among clinical isolates of Escherichia coli in Southern Taiwan. J. Clin. Microbiol. 38, 4320-4325
  9. Brinas, L., M. Zarazaga, Y. Senz, F. Ruiz-Larrea , and C. Torres. 2002. $\beta$-Lactamases in ampicillin-resistant Escherichia coli isolates from foods, humans, and healthy animals. Antimicrob. Agents Chemother. 246, 3156-3163
  10. Gniadkowski, M., I. Schneider, A. Palucha, R. Jungwirth, B. Mikiewicz, and A. Bauernfeind. 1998. Cefotaxime-resistant Enterobacteriaceae isolates from a hospital in Warsaw, Poland: identification of a new CTX-M-3 cefotaxime-hydrolyzing beta-lactamase that is closely related to the CTX-M-1/MEN-1 enzyme. Antimicrob. Agents Chemother. 42, 827-832
  11. Livermore, D.M. 1995. $\beta$-Lctamases in laboratory and clinical resistance. Clin. Microbiol. Rev. 8, 557-584
  12. Oliver, A., M. Prez-Vzquez, M. Martnez-Ferrer, F. Baquero, L. De Rafael, and R. Canton. 1999. Ampicillin-sulbactam and amoxicillin- clavulanate susceptibility testing of Escherichia coli isolates with different $\beta$-lactam resistance phenotypes. Antimicrob. Agents Chemother. 43, 862-867
  13. Pai, H., S. Lyu, J.H. Lee, J. Kim, Y. Kwon, J.W. Kim, and K.W. Choe. 1999. Survey of extended-spectrum $\beta$-lactamases in clinical isolates of Escherichia coli and Klebsiella pneumoniae: prevalence of TEM-52 in Korea. J. Clin. Microbiol. 37, 1758-1763
  14. National Committee for Clinical Laboratory Standards. 2000. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically: Approved Standard-Fifth Edition. NCCLS. 20, 7-10
  15. Nelson, E.C., and B.G. Elisha. 1999. Molecular basis of AmpC hyperproduction in clinical isolates of Escherichia coli. Antimicrob. Agents Chemother. 43, 957-959
  16. Pitout, J.D., M.D. Reisbig, E.C. Venter, D.L. Church, and N.D. Hanson. 2003. Modification of the double-disk test for detection of Enterobacteriaceae producing extended-spectrum and AmpC $\beta$- lactamases. J. Clin. Microbiol. 41, 3933-3935
  17. Lee, S.H., J.Y. Kim, S.H. Shin, Y.J. An, Y.W. Choi, Y.C. Jung, H.I. Jung, E.S. Sohn, S.H. Jeong, and K.J. Lee. 2003. Dissemination of SHV-12 and characterization of new AmpC-type $\beta$-lactamase genes among clinical isolates of Enterobacter species in Korea. J. Clin. Microbiol. 41, 2477-2482
  18. Gniadkowski, M. and W. Hryniewicz. 1998. Outbreak of ceftazidime- resistant Klebsiella pneumoniae in a pediatric hospital in warsaw, Poland: Clonal spread of the TEM-47 extended spectrum $\beta$-lactamase (ESBL)-producing strain and transfer of a plasmid carrying the SHV-5-like ESBL- encoding gene. Antimicrob. Agents Chemother. 42, 3079-3085
  19. Sturenburg, E., D. Mack. 2003. Extended-spectrum $\beta$-lactamases: implications for the clinical microbiology laboratory, therapy, and infection control. J Infect. 47, 273-295
  20. Bradford, P.A. 2001. Extended-spectrum $\beta$-lactamases in the 21st century. Clin. Microbiol. Rev. 114, 933-951
  21. De Champs, C., D. Sirot, C. Chanal, R. Bonnet, J. Sirot, and the French Study Group. 2000. A 1998 Survey of extended-spectrum $\beta$-lactamases in Enterobacteriaceae in France. Antimicrob. Agents Chemother. 44, 3177-3179
  22. Poirel, L., C. Heritier, V. Tolun, P. Nordmann. 2004. Emergence of oxacillinase-mediated resistance to imipenem in Klebsiella pneu moniae. Antimicrob. Agents Chemother. 48, 15-22
  23. Perilli, M., E. Dell’Amico, B. Segatore, M.R. De Massis, C. Bianchi, F. Luzzaro, G.M. Rossolini, A. Toniolo, G. Nicoletti, and G. Amicosante. 2002. Molecular characterization of extended-spectrum $\beta$-lactamases produced by nosocomial isolates of Enterobacteriaceae from an Italian nationwide survey. J. Clin. Microbiol. 40, 611-614
  24. Pai, H., H.J. Lee, E.H. Choi, J. Kim, and G.A. Jacoby. 2001. Evolution of TEM-related extended-spectrum $\beta$-lactamases in Korea. Antimicrob. Agents Chemother. 45, 3651-3653
  25. Bonnet, R., C. Chanal, E. Ageron, D. Sirot, C. De Champs, P. Grimont, and J. Sirot. 2002. Inducible AmpC $\beta$-lactamase of a new member Enterobacteriaceae. Antimicrob. Agents Chemother. 46, 3316-3319
  26. Zhou, X.Y., F. Bordon, D. Sirot, M.D. Kitzis, and L. Gutmann. 1994. Emergence of clinical isolates of Escherichia coli producing TEM-1 derivatives or an OXA-1 beta-lactamase conferring resistance to beta-lactamase inhibitors. Antimicrob. Agents Chemother. 38, 1085-1089