Extended-spectrum cephalosporin-resistant Escherichia coli in community, specialized outpatient clinic and hospital settings in Switzerland

Resistance to extended-spectrum cephalosporins (ESCs) in Escherichia coli can be due to the production of ESBLs, plasmid-mediated AmpCs (pAmpCs) or chromosomal AmpCs (cAmpCs). Information regarding type and prevalence of β-lactamases, clonal relations and plasmids associated with the bla genes for E...

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Bibliographic Details
Published in:Journal of antimicrobial chemotherapy 2013-10, Vol.68 (10), p.2249-2254
Main Authors: Seiffert, Salome N, Hilty, Markus, Kronenberg, Andreas, Droz, Sara, Perreten, Vincent, Endimiani, Andrea
Format: Article
Language:English
Subjects:
Ambulatory Care Facilities
Anti-Bacterial Agents - pharmacology
beta-Lactam Resistance
beta-Lactamases - genetics
beta-Lactamases - secretion
Cephalosporins - pharmacology
Chromosomes
Cloning
Cluster Analysis
Community-Acquired Infections - epidemiology
Community-Acquired Infections - microbiology
Cross Infection - epidemiology
Cross Infection - microbiology
Deoxyribonucleic acid
DNA
DNA, Bacterial - chemistry
DNA, Bacterial - genetics
E coli
Escherichia coli
Escherichia coli - classification
Escherichia coli - drug effects
Escherichia coli - genetics
Escherichia coli - isolation & purification
Escherichia coli Infections - epidemiology
Escherichia coli Infections - microbiology
Genotype
Hospitals
Humans
Microarray Analysis
Mutation
Plasmids
Polymerase Chain Reaction
Sequence Analysis, DNA
Switzerland - epidemiology
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Summary:Resistance to extended-spectrum cephalosporins (ESCs) in Escherichia coli can be due to the production of ESBLs, plasmid-mediated AmpCs (pAmpCs) or chromosomal AmpCs (cAmpCs). Information regarding type and prevalence of β-lactamases, clonal relations and plasmids associated with the bla genes for ESC-R E. coli (ESC-R-Ec) detected in Switzerland is lacking. Moreover, data focusing on patients referred to the specialized outpatient clinics (SOCs) are needed. We analysed 611 unique E. coli isolated during September-December 2011. ESC-R-Ec were studied with microarrays, PCR/DNA sequencing for blaESBLs, blapAmpCs, promoter region of blacAmpC, IS elements, plasmid incompatibility group, and also implementing transformation, aIEF, rep-PCR and MLST. The highest resistance rates were observed in the SOCs, whereas those in the hospital and community were lower (e.g. quinolone resistance of 22.6%, 17.2% and 9.0%, respectively; P = 0.003 for SOCs versus community). The prevalence of ESC-R-Ec in the three settings was 5.3% (n = 11), 7.8% (n = 22) and 5.7% (n = 7), respectively. Thirty isolates produced CTX-M ESBLs (14 were CTX-M-15), 5 produced CMY-2 pAmpC and 5 hyper-expressed cAmpCs due to promoter mutations. Fourteen isolates were of sequence type 131 (ST131; 10 with CTX-M-15). blaCTX-M and blaCMY-2 were associated with an intact or truncated ISEcp1 and were mainly carried by IncF, IncFII and IncI1plasmids. ST131 producing CTX-M-15 is the predominant clone. The prevalence of ESC-R-Ec (overall 6.5%) is low, but an unusual relatively high frequency of AmpC producers (25%) was noted. The presence of ESC-R-Ec in the SOCs and their potential ability to be exchanged between hospital and community should be taken into serious consideration.
ISSN:0305-7453
1460-2091
DOI:10.1093/jac/dkt208