Community and hospital spread of Escherichia coli producing CTX-M extended-spectrum β-lactamases in the UK

Woodford, Neil; Ward, M. Elaina; Kaufmann, Mary E.; Turton, Jane F.; Fagan, Elizabeth J.; James, Deborah; Johnson, Alan P.; Pike, Rachel; Warner, Marina; Cheasty, T.; Pearson, A.; Harry, S.; Leach, J. B.; Loughrey, Anne; Lowes, J. A.; Warren, Richard M.; Livermore, David M.

doi:10.1093/jac/dkh424

Cited by 437 publications

(334 citation statements)

References 24 publications

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“…CTX-M enzymes have been found predominantly in members of the Enterobacteriaceae, most prevalently in E. coli, K. pneumoniae and Salmonella enterica serovar Typhimurium in South America (Radice et al, 2002;Villegas et al, 2004) and Europe (Baraniak et al, 2002;Batchelor et al, 2005;Livermore & Hawkey, 2005), although they are rarely isolated in Japan (Yagi et al, 2000). The spread of CTX-M enzyme-producing E. coli among community-and hospital-based patients has also been reported (Woodford et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

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

Nakano

Abe

et al. 2012

Journal of Medical Microbiology

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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.

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Section: Introductionmentioning

confidence: 99%

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

Nakano

Abe

et al. 2012

Journal of Medical Microbiology

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“…These isolates, which were from six different hospitals and a variety of clinical sources (urine, blood, faeces, sputa and wounds), all produced CTX-M-15 and were believed to comprise a single epidemic strain, designated strain A. Four other major PFGE clusters of related E. coli isolates producing CTX-M-15 were also noted and were designated B to E. Representative isolates of each of the five clusters belonged to the same serotype (O25) and given their close relationship by PFGE (78% similarity), the study investigators suggested they may have had a common ancestry [60]. Subsequent analysis using MLST showed that strains A-E all belonged to an extremely successful clone of E. coli of ST131 which is now known to have disseminated globally [62,63].…”

Section: (I) Enhanced Surveillance Of Methicillin-resistant Staphylocmentioning

confidence: 91%

“…Current UK surveillance data have shown that the majority of bloodstream isolates of E. coli and K. pneumoniae remain susceptible to meropenem, with resistance being seen in 0.1% and 0.9%, respectively in 2013 [49,50]. However, there are clear signs that resistance is nonetheless emerging, with the number of isolates of Gram-negative bacteria noted from about 2000 onwards, with cephalosporin resistance increasingly being seen in E. coli producing CTX-M type ESBLs, particularly CTX-M-15 [59][60][61]. In addition, while ESBL-mediated cephalosporin resistance seen during the 1990s had primarily occurred in hospitals, many of the CTX-M-producing isolates of E. coli were initially obtained from patients in the community [60].…”

Section: (I) Enhanced Surveillance Of Methicillin-resistant Staphylocmentioning

confidence: 99%

“…However, there are clear signs that resistance is nonetheless emerging, with the number of isolates of Gram-negative bacteria noted from about 2000 onwards, with cephalosporin resistance increasingly being seen in E. coli producing CTX-M type ESBLs, particularly CTX-M-15 [59][60][61]. In addition, while ESBL-mediated cephalosporin resistance seen during the 1990s had primarily occurred in hospitals, many of the CTX-M-producing isolates of E. coli were initially obtained from patients in the community [60]. Typing undertaken using pulsed-field gel electrophoresis (PFGE) showed that over a third of the isolates of CTX-M-producing E. coli referred to the national Reference Laboratory from hospitals around the UK during 2003 and early 2004 were highly genetically related.…”

Section: (I) Enhanced Surveillance Of Methicillin-resistant Staphylocmentioning

confidence: 99%

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Surveillance of antibiotic resistance

Johnson

2015

Phil. Trans. R. Soc. B

102

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Surveillance involves the collection and analysis of data for the detection and monitoring of threats to public health. Surveillance should also inform as to the epidemiology of the threat and its burden in the population. A further key component of surveillance is the timely feedback of data to stakeholders with a view to generating action aimed at reducing or preventing the public health threat being monitored. Surveillance of antibiotic resistance involves the collection of antibiotic susceptibility test results undertaken by microbiology laboratories on bacteria isolated from clinical samples sent for investigation. Correlation of these data with demographic and clinical data for the patient populations from whom the pathogens were isolated gives insight into the underlying epidemiology and facilitates the formulation of rational interventions aimed at reducing the burden of resistance. This article describes a range of surveillance activities that have been undertaken in the UK over a number of years, together with current interventions being implemented. These activities are not only of national importance but form part of the international response to the global threat posed by antibiotic resistance.

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“…The presence of bla TEM , bla SHV, bla CTX-M genes and bla PER-1 genes was determined for E. coli strains by polymerase chain reaction (PCR) using primers and conditions as described previously [25][26][27][28]. In brief, bacterial DNA was extracted by boiling and applied to PCRamplification using Taq polymerase (Invitrogen, Germany) under the following conditions: 94°C for 5 min, 35 cycles consisting of 95°C for 30s, 55°C for 30s, and 72°C for 50s each, followed by a final extension at 72°C for 8 min.…”

Section: Characterization Of Extended-spectrum β-Lactamasesmentioning

confidence: 99%