Trends in Production of Extended-Spectrum β-Lactamases among Enterobacteria of Medical Interest: Report of the Second Italian Nationwide Survey

Abstract

Results of a 2003 survey carried out in Italy to evaluate the prevalence of extended-spectrum ␤-lactamase (ESBL)-producing enterobacteria are presented. Eleven Italian Microbiology Laboratories investigated 9,076 consecutive nonreplicate isolates (inpatients, 6,850; outpatients, 2,226). ESBL screening was performed by MIC data analysis. Confirmation was obtained using the double-disk synergy test and the combination disk test based on CLSI methodology. ESBL determinants were investigated by colony blot hybridization and confirmed by sequencing. Results were compared to those of the 1999 Italian survey (8,015 isolates). The prevalence of ESBL producers was 7.4% among isolates from inpatients (in 1999, 6.3%) and 3.5% among outpatients (no data were available for 1999). Among hospitalized patients, the most prevalent ESBL-positive species was Escherichia coli (Klebsiella pneumoniae in 1999). Proteus mirabilis was the most prevalent ESBLpositive species among outpatients. In both groups, most ESBL-positive pathogens were obtained from urinary tract infections. TEM-type ESBLs were the most prevalent enzymes (45.4%). Non-TEM, non-SHV determinants emerged: CTX-M-type in E. coli and K. pneumoniae, and PER-type in P. mirabilis, Providencia spp., and E. coli. With the exception of 3/163 P. mirabilis isolates and 1/44 Providencia stuartii isolate (all of which were intermediate for imipenem), carbapenems were active against all ESBL-positive enterobacteria. Susceptibility to other drugs was as follows: 84.7% for amikacin, 84.4% for piperacillin-tazobactam, 48.0% for gentamicin, and 32.8% for ciprofloxacin. Carbapenems appear to be the drug of choice. Amikacin and ␤-lactam/␤-lactamase inhibitor combinations represent an alternative in non-life-threatening infections. The appearance of ESBL-positive enterobacteria in the community makes it mandatory that family physicians learn how to treat these pathogens.Extended-spectrum ␤-lactamases (ESBLs) are enzymes capable of hydrolyzing a wide range of expanded-spectrum ␤-lactams, including most recent cephalosporins, but which are inactive against cephamycins and carbapenems (15). To date, more than 150 different natural ESBL variants (which are detected most frequently in enterobacteria) are known,

Nosocomial infection and characterization of extended-spectrum β-lactamases-producing Enterobacteriaceae in Northeast Brazil

“…In addition, the occurrence of this microorganism was higher than that of the other species in one of the hospitals (H2). The prevalence of E. aerogenes exceeded those found in Italy 15 . In contrast, other Brazilian studies have reported a higher prevalence of E. cloacae 13 .…”

“…Similar results have been reported in members of the family Enterobacteriaceae 7,13,18,19 and in a multicenter study investigating bacterial resistance in Brazilian hospitals 6 . In contrast, E. coli was found to be the most prevalent ESBL-producing microorganism in Saudi Arabia 1 , France 16 and Italy 15 .…”

“…The rate of ESBL-producing microorganisms within the Enterobacteriaceae family is 11.1% in Poland 14 , 7.4% in Italy 15 , 6% in Saudi Arabia 1 , 1.7% in France 16 , and 30 to 60% in Latin America 17 . These data indicate that the prevalence of bacteria expressing the ESBL phenotype varies significantly in different regions and hospitals within the same region.…”

Enterobactérias produtoras de ESBL em Passo Fundo, estado do Rio Grande do Sul, Brasil

“…O monitoramento da ocorrência de cepas produtoras de ESBL em enterobactérias de interesse clínico contribui para delinear a amplitude do MÉTODOS RESULTADOS problema e para definir opções de tratamento e medidas de contenção adequadas 17 …”

Prevalência das famílias TEM, SHV e CTX-M de β-lactamases de espectro estendido em Escherichia coli e Klebsiella spp no Hospital Universitário de Santa Maria, Estado do Rio Grande do Sul

“…O monitoramento da prevalência e dos tipos de ESBLs é fundamental para o melhor entendimento desse problema e para a definição de apropriadas opções terapêuticas 12 . No Brasil, embora isolados clínicos produtores de ESBL tenham sido ocasionalmente relatados, 8 16 26 estudos com relação a prevalência das famílias de ESBL merecem ser abordados.…”