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Carga de Enterobacterias productoras de β‐lactamasas de espectro extendido en heces humanas en Java, Indonesia, en 2001–2002
Author(s) -
Severin Juliëtte A.,
Lestari Endang Sri,
Kloezen Wendy,
Lemmensden Toom Nicole,
Mertaniasih Ni Made,
Kuntaman Kuntaman,
Purwanta Marijam,
Offra Duerink D.,
Hadi Usman,
van Belkum Alex,
Verbrugh Henri A.,
Goessens Wil H.
Publication year - 2012
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2011.02949.x
Subject(s) - enterobacteriaceae , pulsed field gel electrophoresis , microbiology and biotechnology , carriage , klebsiella pneumoniae , biology , cefotaxime , escherichia coli , genotype , medicine , antibiotics , genetics , gene , pathology
Objective To characterise commensal Escherichia coli and other Enterobacteriaceae with reduced susceptibility to cefotaxime that were collected in a large survey carried out among 3995 patients and healthy persons in two urban regions on Java, Indonesia, in 2001–2002. Methods The putative extended‐spectrum β‐lactamase (ESBL)‐producing Enterobacteriaceae were analysed using double‐disk synergy tests, isoelectric focusing, PCR assays, DNA sequencing, and pulsed‐field gel electrophoresis (PFGE). Results On the day of discharge after five or more days of hospitalisation, at least 95 of 999 (9.5%) patients carried ESBL‐positive Enterobacteriaceae as dominant faecal flora. Six patients were simultaneously colonised with E. coli and Klebsiella pneumoniae isolates with ESBL activity. On admission, only 6 of 998 (0.6%) patients were colonised. Faecal carriage of ESBL‐producing Enterobacteriaceae among healthy persons or persons visiting a public health centre was not detected. The 107 ESBL‐positive strains included 68 E. coli , 35 K. pneumoniae , and four other Enterobacteriaceae. bla CTX‐M‐15 was the most prevalent ESBL in both E. coli (47.1%) and K. pneumoniae (45.7%), but the E. coli O25b‐ST131 clone was virtually absent. Other ESBL types found were: SHV‐2, ‐2a, ‐5, ‐12, CTX‐M‐3, ‐9, ‐14, and TEM‐19. PFGE revealed extensive genetic diversity among the isolates. Conclusions In 2001–2002, faecal carriage of ESBL‐producing Enterobacteriaceae as dominant flora in Indonesia was almost exclusively hospital‐associated. The presence of various bla ESBL genes and the extensive genetic diversity among isolates argue against a single/dominant strain outbreak.