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The incidence of extended-spectrum β-lactamases (ESBLs) has been increasing worldwide, but screening criteria for detection of ESBLs are not standardized for AmpC-producing Enterobacteriaceae such as  Enterobacter  species. In this study, we investigated the prevalence of ESBLs and/or AmpC β-lactamases in Japanese clinical isolates of  Enterobacter  spp. and the association of plasmid-mediated quinolone resistance (PMQR) determinants with ESBL producers. A total of 364 clinical isolates of  Enterobacter  spp. collected throughout Japan between November 2009 and January 2010 were studied. ESBL-producing strains were assessed by the CLSI confirmatory test and the boronic acid disk test. PCR and sequencing were performed to detect CTX-M, TEM, and SHV type ESBLs and PMQR determinants. For ESBL-producing  Enterobacter  spp., pulsed-field gel electrophoresis (PFGE) was performed using  Xba I restriction enzyme. Of the 364 isolates, 22 (6.0%) were ESBL producers. Seven isolates of  Enterobacter cloacae  produced CTX-M-3, followed by two isolates producing SHV-12. Two isolates of  Enterobacter aerogenes  produced CTX-M-2. Of the 22 ESBL producers, 21 had the AmpC enzyme, and six met the criteria for ESBL production in the boronic acid test. We found a significant association of  qnrS  with CTX-M-3-producing  E. cloacae . The 11 ESBL-producing  Enterobacter  spp. possessing  bla   CTX-M ,  bla   SHV , or  bla   TEM  were divided into six unique PFGE types. This is the first report about the prevalence of  qnr  determinants among ESBL-producing  Enterobacter  spp. from Japan. Our results suggest that ESBL-producing  Enterobacter  spp. with  qnr  determinants are spreading in Japan.

Molecular Characteristics of Extended-Spectrum Beta-Lactamases and qnr Determinants in Enterobacter Species from Japan