This study was conducted to detect the genes encoding extended-spectrum b-lactamases (ESBLs) and determine the epidemiological relatedness of 69 Escherichia coli and 33 Klebsiella pneumoniae isolates collected from a regional hospital in central Taiwan, mostly from inpatients (E. coli 87.0 %; K. pneumoniae 88.0 %). The phenotypes of these isolates were examined according to the combination disc method recommended by the Clinical and Laboratory Standards Institute. Most of the ESBL-producing E. coli and K. pneumoniae isolates (98.6 % and 97 %, respectively) could be detected using cefotaxime discs with and without clavulanate. Genotyping was performed by PCR with type-specific primers. CTX-M-14 type (53.6 %) was the most prevalent ESBL among E. coli isolates while SHV type (57.6 %) was the most dominant among K. pneumoniae isolates. Six E. coli and three K. pneumoniae isolates did not carry genes encoding ESBLs of types TEM, SHV, CTX-M-3, CTX-M-14, CMY-2 and DHA-1. The co-existence of two or more kinds of ESBL in a single isolate was common, occurring in 40.6 % and 72.7 % of E. coli and K. pneumoniae isolates, respectively. PFGE analysis revealed that ESBL producers isolated in this setting were genetically divergent.
INTRODUCTIONSince the first report in Germany in 1983 (Knothe et al., 1983), the emergence of extended-spectrum b-lactamase (ESBL)-producing Klebsiella pneumoniae and Escherichia coli has become a serious problem in hospitalized patients worldwide (Hawser et al., 2009;Livermore et al., 2007;Paterson & Bonomo, 2005). In Taiwan, the prevalence of ESBL producers has increased in recent years, ranging from 8.5 to 50.7 % in K. pneumoniae and 1.5 to 25.4 % in E. coli (Jean et al., 2009;Kuo et al., 2008;Yu et al., 2006).According to Ambler's classification, ESBLs belong to the class A b-lactamases, which possess an active-site serine residue essential for the inactivation of b-lactam antimicrobial drugs (Ambler, 1980). The term 'extendedspectrum b-lactamase' was originally applied to describe the TEM and SHV variants that can hydrolyse oxyiminocephalosporins (Paterson & Bonomo, 2005). The 'extended spectrum' of activity is defined in terms of hydrolysing oxyimino-cephalosporins or aztreonam at more than 10 % of the activity of hydrolysing benzylpenicillin. Generally, ESBLs confer resistance to all penicillins, first-to-fourth generation cephalosporins and monobactams, but not to cephamycins or carbapenems. However, like many other class A b-lactamases, ESBLs are inactivated by the blactamase inhibitors, such as clavulanate (Bradford, 2001). Most of the genes encoding ESBLs are plasmid-borne and are often located in the transposons and integrons (Eckert et al., 2006), facilitating their mobilization with other resistance determinant. Thus the genes encoding ESBLs may be easily transferred between bacteria.The most prevalent ESBLs are included in three groups: TEM, SHV and CTX-M. The SHV enzymes are named Isoelectric focusing. Bacteria cultured in Mueller-Hinton broth for 20 h were centrifuged and the pellet...