Medical Microbiology and Infection Control, VU University Medical Centre, Amsterdam, the Netherlands.
Clin Microbiol Infect. 2013 Jun;19(6):542-9. doi: 10.1111/j.1469-0691.2012.03947.x. Epub 2012 Jul 3.
The aim of this study was to determine the rate of carriage of ESBL-producing Enterobacteriaceae (ESBL-E) in the community in the Netherlands and to gain understanding of the epidemiology of these resistant strains. Faecal samples from 720 consecutive patients presenting to their general practitioner, obtained in May 2010, and between December 2010 and January 2011, were analysed for presence of ESBL-E. Species identification and antibiotic susceptibility testing were performed according to the Dutch national guidelines. PCR, sequencing and microarray were used to characterize the genes encoding for ESBL. Strain typing was performed with amplified fragment length polymorphism (AFLP) and multilocus sequence typing (MLST). Seventy-three of 720 (10.1%) samples yielded ESBL-producing organisms, predominantly E. coli. No carbapenemases were detected. The most frequent ESBL was CTX-M-15 (34/73, 47%). Co-resistance to gentamicin, ciprofloxacin and cotrimoxazole was found in (9/73) 12% of the ESBL-E strains. AFLP did not show any clusters, and MLST revealed that CTX-M-15-producing E. coli belonged to various clonal complexes. Clonal complex ST10 was predominant. This study showed a high prevalence of ESBL-producing Enterobacteriaceae in Dutch primary care patients with presumed gastrointestinal discomfort. Hence, also in the Netherlands, a country with a low rate of consumption of antibiotics in humans, resistance due to the expansion of CTX-M ESBLs, in particular CTX-M-15, is emerging. The majority of ESBL-producing strains do not appear to be related to the international clonal complex ST131.
本研究旨在确定荷兰社区中产超广谱β-内酰胺酶（ESBL）肠杆菌科（ESBL-E）的携带率，并了解这些耐药菌株的流行病学情况。2010 年 5 月和 2010 年 12 月至 2011 年 1 月期间，从 720 名连续就诊于其全科医生的患者中采集粪便样本，用于分析 ESBL-E 的存在。根据荷兰国家指南进行物种鉴定和抗生素药敏试验。采用 PCR、测序和微阵列技术对编码 ESBL 的基因进行特征分析。采用扩增片段长度多态性（AFLP）和多位点序列分型（MLST）进行菌株分型。720 个样本中的 73 个（10.1%）样本产生了产 ESBL 的生物体，主要是大肠杆菌。未检测到碳青霉烯酶。最常见的 ESBL 是 CTX-M-15（34/73，47%）。在 73 株 ESBL-E 菌株中，有 9 株（12%）存在对庆大霉素、环丙沙星和复方新诺明的协同耐药。AFLP 未显示任何聚类，MLST 表明 CTX-M-15 产生的大肠杆菌属于各种克隆复合体。CTX-M-15 产生的大肠杆菌主要属于克隆复合体 ST10。本研究表明，荷兰初级保健患者中出现了高比例的胃肠道不适假定的产 ESBL 肠杆菌科。因此，在荷兰这个抗生素在人类中使用率较低的国家，CTX-M ESBL 尤其是 CTX-M-15 的扩展导致了耐药性的出现。大多数产 ESBL 菌株似乎与国际克隆复合体 ST131 无关。
