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The emergence of extended-spectrum β-lactamase (ESBL)producing bacteria, particularly Escherichia coli and Klebsiella pneumoniae, is now a critical concern for the development of therapies against bacterial infection. Since the early 1980s, the number of nosocomial infections by ESBL-producing, gram-negative bacteria has been increasing worldwide, and β-lactamase production has become a major causative factor for increasing resistance to antibiotics [1-3]. The ESBL genes are mostly plasmid encoded [4], and most ESBLs can be divided into 3 genotypes: TEM, SHV, and CTX-M [5]. The major ESBL producer was K. pneumoniae before 2000, and the predominant ESBL genotypes were TEM and SHV [1]. E. coli has now become an important ESBL carrier in Western countries. In addition, a genotype CTX-M has become more prevalent worldwide compared to the TEM and SHV genotypes [1]. During the 1990s, ESBL-producing organisms were described mainly as members of the TEMand SHV-β-lactamase families in E. coli and K. pneumoniae causing nosocomial outbreaks [6]. In the 1990s, a novel type of ESBL, the CTX-M enzyme, emerged worldwide [6]. The CTX-M types, now exceeding 50 different types, can be divided into 5 groups based on their amino acid identities: CTX-M-1, CTX-M-2, CTX-M-8, CTX-M-9, and CTX-M-25 [7]. It is clear that various CTX-M type ESBLs have spread worldwide and that specific CTX-M subgroups have been localized to different geographic areas [1,8,9]. Thus, in Japan, it is known that the CTX-M-8 and CTX-M-25 groups of enzymes are rarely found [10]. In Japan, since the first isolate of ESBL-producing bacterium in 1993 [11], the detection rates of ESBL-producers have been much lower than those in the rest of Asia; however, the increase in the incidence of ESBL producers remains a common issue [12,13]. Because the current trend of both bacteria in Japan is unknown and few studies with longitudinal observations of the nosocomial spread of these bacteria have been reported [14], we investigated epidemiologic data on the ESBL-producing E. coli and K. pneumoniae in our hospital and the ESBL genotypes. In addition, the antimicrobial susceptibilities of the ESBL producers were examined.

journal of medical microbiology and diagnosis

Clinical and Molecular Epidemiology of Extended-Spectrum β-lactamase- Producing Klebsiella pneumoniae and Escherichia Coli in a Japanese Tertiary Hospital