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Antibiotic susceptibility of extended-spectrum
ß-lactamase-producing Enterobacteriaceae
Antibiotic Reference Laboratory, Communicable Disease Group, Institute of Environmental Science and Research (ESR), PO Box 50-348, Porirua. Email: ARL@esr.cri.nz Introduction

Extended-spectrum ß-lactamases (ESBLs) confer resistance to all • The plasmids may also carry other resistance genes.
• Overseas studies have reported that ESBL-producing bacteria are usually • ESBLs are most commonly found in Klebsiella and Escherichia coli, but are multiresistant to several classes of antibiotics, especially fluoroquinolones and now also being identified in other Enterobacteriaceae, such as Enterobacter. • ESBL-producing organisms are being isolated with increasing frequency in • Little has been published about antimicrobial resistance among ESBL- • The ESBL genes are carried on plasmids and therefore can be readily Therefore, we determined the susceptibility of ESBL-producing transferred within and between species.
Enterobacteriaceae, recently isolated from throughout NZ, to a range of antibiotics.
Methods
As part of a survey of methods to detect ESBLs, we tested the susceptibility of
Multiresistance was defined as, in addition to cephalosporin and monobactam a representative sample of 137 isolates of ESBL-producing Enterobacteriaceae resistance, resistance to >3 of the following antibiotic classes: co-amoxiclav, to amikacin, ciprofloxacin, co-amoxiclav, co-trimoxazole, gentamicin, meropenem, ciprofloxacin, aminoglycosides (gentamicin, tobramycin and/or meropenem, nitrofurantoin, tetracycline, tobramycin and trimethoprim, by agar amikacin), folate pathway inhibitors (co-trimoxazole and/or trimethoprim), dilution according to CLSI/NCCLS methodology and interpretive standards.1 The isolates tested had been referred to ESR from throughout NZ. Duplicateisolates from a patient were excluded and only one isolate of any recognisedoutbreak strain was included.
Results
Table 1 and Chart 1 show resistance to the individual antibiotics and antibiotic
Chart 1. Rates of resistance
classes. The rates of resistance are similar to those found in overseas studiesand a recent NZ study.2,3 % resistant
Table 2 shows the frequency of multiresistance.
Chart 2 shows the resistance patterns that were observed in >5% of isolates.
Table 1. Rates of resistance among ESBL-positive Enterobacteriaceae
Percent resistance
Antibiotic
E. coli
Klebsiella
Enterobacteriaceae
Other Enterobacteriaceae
Tetracycline amoxiclav
E.coli
ofurantoin
trimoxazole
Klebsiella species
Gentamicin
Tobramycin
Amikacin
Chart 2. Resistance patterns
with each
E. coli
tetracycline
ciprofloxacin
folate pathway inhibitor
aminoglycoside
tetracycline
ciprofloxacin
folate pathway inhibitor
aminoglycoside
co-amoxiclav
tetracycline
ciprofloxacin
aminoglycoside
tetracycline
ciprofloxacin
aminoglycoside
co-amoxiclav
tetracycline
folate pathway inhibitor
aminoglycoside
tetracycline
ciprofloxacin
folate pathway inhibitor
folate pathway inhibitor
Table 2. Multiresistance rates
Klebsiella species
aminoglycoside
folate pathway inhibitor
tetracycline
Resistant to
aminoglycoside
folate pathway inhibitor
(number of
E. coli
Klebsiella
aminoglycoside
tetracycline
folate pathway inhibitor
tetracycline
nitrofurantoin
ciprofloxacin
antibiotic species
Enterobacteriaceae
aminoglycoside
folate pathway inhibitor
tetracycline
ciprofloxacin
aminoglycoside
folate pathway inhibitor
co-amoxiclav
classes):
Other Enterobacteriaceae
folate pathway inhibitor
co-amoxiclav
aminoglycoside
tetracycline
folate pathway inhibitor
co-amoxiclav
aminoglycoside
folate pathway inhibitor
co-amoxiclav
aminoglycoside
tetracycline
nitrofurantoin
folate pathway inhibitor
co-amoxiclav
aminoglycoside
tetracycline
ciprofloxacin
Conclusions
References
1. National Committee for Clinical Laboratory Standards. Methods for dilution antimicrobial susceptibility tests for
• The majority of ESBL-producing Enterobacteriaceae in NZ are multiresistant to bacteria that grow aerobically; approved standard - sixth edition. Pennsylvania: NCCLS; 2003. M7-A6.
2. Bell JM, Turnidge JD, Gales AC, Pfaller MA, Jones RN. Prevalence of extended spectrum beta-lactamase (ESBL)- producing clinical isolates in the Asia-Pacific region and South Africa: regional results from SENTRY Antimicrobial • Resistance to gentamicin, tobramycin, co-trimoxazole, trimethoprim and Surveillance Program (1998-99). Diagn Microbiol Infect Dis 2002; 42: 193-8.
3. Briggs S, Ussher J, Taylor S. Extended-spectrum beta-lactamase-producing Enterobacteriaceae at Middlemore • In addition, most ESBL-positive E. coli are resistant to fluoroquinolones.
Hospital. NZ Med J 2005; 118 (1218). Available at http://www.nzma.org.nz/journal/118-1218/1563/ • All ESBL-producing Enterobacteriaceae were susceptible to the carbapenem These results are part of a report on ESBLs to be published on the ESR We thank the microbiology laboratories throughout New Zealand whoreferred ESBL-producing organisms to ESR for our surveillance Surveillance Website: http://www.surv.esr.cri.nz/antimicrobial/esbl.php

Source: http://www.esr.cri.nz/SiteCollectionDocuments/ESR/PDF/Health/NZIMLS%202005%20ESBL%20poster.pdf

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