Laboratoire de Microbiologie, Hôpital Universitaire Erasme, Université Libre de Bruxelles, B-1070 Brussels, Belgium.
J Antimicrob Chemother. 2011 Jan;66(1):37-47. doi: 10.1093/jac/dkq388. Epub 2010 Oct 28.
to assess the frequency and diversity of extended-spectrum β-lactamases (ESBLs) in Enterobacteriaceae isolates in Belgium.
during 2006 and 2008, non-duplicate clinical isolates of Enterobacteriaceae resistant to ceftazidime and/or cefotaxime were collected in 100 Belgian hospitals. ESBL production was confirmed by phenotypic and genotypic tests. MICs of 13 antimicrobial agents were determined by Etest. ESBL-encoding genes were identified by PCR sequencing and the bla(CTX-M) environment was characterized by PCR mapping. Selected isolates were genotyped by PFGE, multilocus sequence typing analysis and phylogenetic grouping by PCR.
overall, 733 isolates were confirmed as ESBL producers. Carbapenems and temocillin were active against ≥ 95% of all tested isolates. Co-resistance to co-trimoxazole and to ciprofloxacin was found in almost 70% and 80% of the strains, respectively. Overall, Escherichia coli (49%), Enterobacter aerogenes (32%) and Klebsiella pneumoniae (9%) represented the most prevalent species. Isolates harboured predominantly TEM-24 (30.7%), CTX-M-15 (24.2%) and TEM-52 (12.1%). Compared with 2006, the proportion of CTX-M-type enzymes increased significantly in 2008 (54% versus 23%; P < 10(-6)), mostly linked to a rising proportion of CTX-M-15-producing E. coli. TEM-24 decreased (19% in 2008 versus 43% in 2006; P < 10(-6)) during the same period, while the prevalence of TEM-52 remained unchanged (10% in 2008 versus 14% in 2006; not significant). Over 80% of the CTX-M-15-producing E. coli isolates clustered into a single PFGE type and phylogroup B2, corresponding to the sequence type (ST) 131 clone. Intra- and inter-species gene dissemination (CTX-M-15, CTX-M-2 and CTX-M-9) and wide epidemic spread of the CTX-M-15-producing E. coli ST131 clone in several Belgian hospitals were observed.
the rapid emergence of multiresistant CTX-M-15-producing E. coli isolates is of major concern and highlights the need for further surveillance in Belgium.
评估比利时产肠杆菌科中扩展谱β-内酰胺酶（ESBLs）的频率和多样性。
在 2006 年和 2008 年期间，在 100 家比利时医院中收集了对头孢他啶和/或头孢噻肟耐药的非重复临床产肠杆菌科分离株。通过表型和基因试验确认 ESBL 产生。通过 Etest 测定 13 种抗菌药物的 MIC。通过 PCR 测序鉴定 ESBL 编码基因，并通过 PCR 图谱分析 bla(CTX-M)环境。对选定的分离株进行 PFGE、多位点序列分型分析和基于 PCR 的系统发育分组。
总体而言，733 株被确认为 ESBL 产生者。碳青霉烯类和替莫西林对所有测试分离株的活性均≥95%。几乎 70%和 80%的菌株对复方新诺明和环丙沙星的耐药性分别为共同耐药。总体而言，大肠埃希菌（49%）、产气肠杆菌（32%）和肺炎克雷伯菌（9%）是最常见的物种。分离株主要携带 TEM-24（30.7%）、CTX-M-15（24.2%）和 TEM-52（12.1%）。与 2006 年相比，2008 年 CTX-M 型酶的比例显著增加（54%对 23%；P<10(-6)），主要与产 CTX-M-15 的大肠埃希菌比例上升有关。同期 TEM-24 减少（2008 年 19%对 2006 年 43%；P<10(-6)），而 TEM-52 的流行率保持不变（2008 年 10%对 2006 年 14%；无显著性）。超过 80%的产 CTX-M-15 的大肠埃希菌分离株聚类为单一 PFGE 型和 B2 phylogroup，对应于序列型（ST）131 克隆。CTX-M-15、CTX-M-2 和 CTX-M-9 之间的种内和种间基因传播以及几种比利时医院中 CTX-M-15 产大肠埃希菌 ST131 克隆的广泛流行传播均观察到。
多耐药 CTX-M-15 产大肠埃希菌分离株的迅速出现令人严重关切，并强调需要在比利时进一步监测。
