Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.
Trop Med Int Health. 2012 Apr;17(4):455-61. doi: 10.1111/j.1365-3156.2011.02949.x. Epub 2012 Jan 16.
To characterise commensal Escherichia coli and other Enterobacteriaceae with reduced susceptibility to cefotaxime that were collected in a large survey carried out among 3995 patients and healthy persons in two urban regions on Java, Indonesia, in 2001-2002.
The putative extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae were analysed using double-disk synergy tests, isoelectric focusing, PCR assays, DNA sequencing, and pulsed-field gel electrophoresis (PFGE).
On the day of discharge after five or more days of hospitalisation, at least 95 of 999 (9.5%) patients carried ESBL-positive Enterobacteriaceae as dominant faecal flora. Six patients were simultaneously colonised with E. coli and Klebsiella pneumoniae isolates with ESBL activity. On admission, only 6 of 998 (0.6%) patients were colonised. Faecal carriage of ESBL-producing Enterobacteriaceae among healthy persons or persons visiting a public health centre was not detected. The 107 ESBL-positive strains included 68 E. coli, 35 K. pneumoniae, and four other Enterobacteriaceae. bla(CTX-M-15) was the most prevalent ESBL in both E. coli (47.1%) and K. pneumoniae (45.7%), but the E. coli O25b-ST131 clone was virtually absent. Other ESBL types found were: SHV-2, -2a, -5, -12, CTX-M-3, -9, -14, and TEM-19. PFGE revealed extensive genetic diversity among the isolates.
In 2001-2002, faecal carriage of ESBL-producing Enterobacteriaceae as dominant flora in Indonesia was almost exclusively hospital-associated. The presence of various bla(ESBL) genes and the extensive genetic diversity among isolates argue against a single/dominant strain outbreak.
描述在 2001-2002 年于印度尼西亚爪哇的两个城市地区对 3995 名患者和健康人进行的一项大型调查中收集的对头孢噻肟敏感性降低的共生大肠杆菌和其他肠杆菌科细菌。
采用双碟协同试验、等电聚焦、PCR 检测、DNA 测序和脉冲场凝胶电泳（PFGE）分析疑似产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌。
在住院 5 天以上的出院日，999 名患者中有 95 名（9.5%）至少携带一种作为主要粪便菌群的 ESBL 阳性肠杆菌科细菌。6 名患者同时定植有产 ESBL 活性的大肠埃希菌和肺炎克雷伯菌。入院时，998 名患者中仅有 6 名定植。健康人或到公共卫生中心就诊的人粪便中未检出产 ESBL 的肠杆菌科细菌。107 株 ESBL 阳性株包括 68 株大肠埃希菌、35 株肺炎克雷伯菌和 4 株其他肠杆菌科细菌。bla（CTX-M-15）是大肠埃希菌（47.1%）和肺炎克雷伯菌（45.7%）中最常见的 ESBL，但 E. coli O25b-ST131 克隆几乎不存在。其他发现的 ESBL 类型包括 SHV-2、-2a、-5、-12、CTX-M-3、-9、-14 和 TEM-19。PFGE 显示分离株之间存在广泛的遗传多样性。
2001-2002 年，印度尼西亚以 ESBL 产肠杆菌科细菌为主要菌群的粪便携带几乎完全与医院相关。各种 bla（ESBL）基因的存在和分离株之间广泛的遗传多样性表明不存在单一/优势菌株爆发。
