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J Antimicrob Chemother. 2006 Aug;58(2):320-6. Epub 2006 May 30.

Prevalence and mechanisms of cephalosporin resistance in Enterobacteriaceae in London and South-East England.

Author information

1
Healthcare-Associated Infection and Antimicrobial Resistance Department, Health Protection Agency Centre for Infections 61 Colindale Avenue, London NW9 5EQ, UK. nicola.potz@HPA.org.uk

Abstract

OBJECTIVES:

To investigate the molecular epidemiology of Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLs) in London and South-East England.

METHODS:

A prospective study involving 16 hospital microbiology laboratories in London and South-East England was undertaken over a 12 week period. Each laboratory submitted up to 100 consecutive cephalosporin-resistant Enterobacteriaceae isolates judged clinically significant by microbiology staff. Centralized testing was undertaken to confirm organism identification and cephalosporin resistance and to analyse resistance mechanisms.

RESULTS:

The predominant mechanism of cephalosporin resistance in isolates from both hospital and community settings was the production of CTX-M-type ESBLs, with CTX-M-producing Escherichia coli as the most numerous resistant organism overall. Other major mechanisms of cephalosporin resistance included production of non-CTX-M ESBLs and AmpC beta-lactamases. Most ESBL (both CTX-M and non-CTX-M) producers were multiply resistant to non-beta-lactam antibiotics, including trimethoprim, ciprofloxacin and gentamicin.

CONCLUSIONS:

CTX-M enzymes, which were unrecorded in the UK prior to 2000, have become the major mechanism of cephalosporin resistance in Enterobacteriaceae in South-East England. E. coli has overtaken Klebsiella and Enterobacter spp. to become the major host for ESBLs. Due to the multiple antibiotic resistance exhibited by many ESBL-producers, these changes have major implications for antimicrobial therapy.

PMID:
16735428
DOI:
10.1093/jac/dkl217
[Indexed for MEDLINE]

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