Nosocomial outbreak of CTX‐M‐15‐producing E. coli in Norway
2007; Wiley; Volume: 115; Issue: 2 Linguagem: Inglês
10.1111/j.1600-0463.2007.apm_547.x
ISSN1600-0463
AutoresUmaer Naseer, Olav Natås, Bjørg Haldorsen, BERIT BUE, Heidi Grundt, Timothy R. Walsh, Arnfinn Sundsfjord,
Tópico(s)Antibiotics Pharmacokinetics and Efficacy
ResumoSeven E. coli isolates expressing resistance to 3rd generation cephalosporins were recovered from blood (n=2), kidney and lung tissue (n=1), and urinary tract (n=4) samples from seven patients hospitalised or recently discharged from the Divisions of Geriatrics and Pulmonary Medicine, Central Hospital of Rogaland, between July and September 2004. All isolates expressed a typical ESBL‐cefotaximase profile (cefotaxime MIC>ceftazidime MIC) with clavulanic acid synergy. A bla CTX‐M‐15 genotype was confirmed in six strains that were coresistant to gentamicin, nitrofurantoin, trimethoprim‐sulfamethoxazole and ciprofloxacin. A bla CTX‐M‐3 genotype was detected in the last strain. Xba I‐PFGE patterns of the six bla CTX‐M‐15 isolates revealed a clonal relationship. Bla CTX‐M‐15 strains were also positive for the IS Ecp1 ‐like insertion sequences that have been shown to be involved in the mobilization of bla CTX‐M. Further analyses revealed two bla CTX‐M‐15 ‐positive E. coli urinary isolates clonally related to the outbreak strain from two different patients at the same divisions in January and February 2004. These patients were later re‐hospitalised and one had E. coli with an ESBL‐cefotaximase profile in sputum and nasopharyngeal specimen during the outbreak period. Clinical evaluation suggests that the CTX‐M‐producing E. coli strains contributed to death in three patients due to delayed efficient antimicrobial therapy. The outbreak emphasises the epidemic potential of multiple‐antibiotic‐resistant CTX‐M‐15‐producing E. coli also in a country with low antibiotic usage and low prevalence of antimicrobial resistance.
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