Hae Suk Cheong; Kwan Soo Ko; Cheol-In Kang; Doo Ryeon Chung; Kyong Ran Peck; Jae-Hoon Song

doi:10.3947/ic.2010.42.5.280

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Cheong, Ko, Kang, Chung, Peck, and Song: Prevalence of Extended-spectrum β-lactamase among Enterobacteriacae Blood Isolates with Inducible AmpC β-lactamase

Original Article

Infection & Chemotherapy

Infection & Chemotherapy 2010; 42(5): 280-284.

Published online: 31 October 2010

DOI: https://doi.org/10.3947/ic.2010.42.5.280

Prevalence of Extended-spectrum β-lactamase among Enterobacteriacae Blood Isolates with Inducible AmpC β-lactamase

Hae Suk Cheong¹, Kwan Soo Ko², Cheol-In Kang³, Doo Ryeon Chung³, Kyong Ran Peck³, Jae-Hoon Song³

¹Division of Infectious Diseases, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Korea.

²Department of Molecular Cell Biology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

³Division of Infectious Disease, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Correspondence to Kyong Ran Peck, M.D. Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea. Tel : +82-2-3410-0329, Fax : +82-2-3410-0041, krpeck@skku.edu

Received 4 January 2010 Revised 20 September 2010 Accepted 24 September 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Among the inducible AmpC β-lactamase-producing members of the family Enterobacteriaceae such as Enterobacter spp., Citrobacter spp., Serratia spp., and Morganella morganii (ECSM), the prevalence of ESBL-producing isolates are increasing. However, there have been only a limited number of studies that have investigated the prevalence for ESBL-production in blood isolates of these organisms.

Materials and Methods

We performed a prospective observational study to evaluate the prevalence for ESBL production among ECSM blood isolates. All consecutive blood isolates in the Samsung Medical Center were included from Oct 2006 to Mar 2008. Antimicrobial susceptibility test was performed by broth microdilution method. ESBLs were confirmed by double-disk synergy test and ESBL phenotypes were determined by PCR.

Results

The 124 isolates (94 Enterobacter spp., 18 Citrobacter spp., 8 Serratia spp. and 4 Morganella spp.) were investigated. Among 124 ESCM isolates, 30 isolates (24.2%) showed ESBL-producing activity. Derepressed or partially derepressed AmpC mutants and derepressed AmpC mutants with ESBL production accounted for 36.3% (45/124) and 16.9% (21/124), respectively. Of ESBL producers, the most prevalent ESBL was SHV-12 (5/24, 20.8%).

Conclusions

The prevalence of ESBL-producing isolates is high in Enterobacter spp., Serratia marcescens and Citrobacter spp. clinical isolates. It suggested that routine screening test for ESBLs among Enterobacteriacae blood isolates with inducible AmpC β-lactamase should be needed.

Keywords: Enterobacter spp., Extended-spectrum β-lactamase, AmpC β-lactamase

Figures and Tables

Figure 1

Difference of cefepime MICs between derepressed AmpC β-lactamase producing isolates and derepressed AmpC β-lactamase with ESBL producing isolates.

FEP, cefepime.

Table 1

MICs of antibiotics for Enterobacter spp., Citrobacter spp., Serratia spp., and Morganella morganii (ECSM) Clinical Isolates

MIC, minimal inhibitory concentration; S, susceptible; I, intermediate; R, resistant

Table 2

Antimicrobial Susceptibilities, Cefoxitin-cefotaxime Antagonism Test, and Confirmatory Test for ESBL Production among 124 ECSM Isolates

ECSM, Enterobacter spp., Citrobacter spp., Serratia spp., Morganella morganii

^aRemaining 11 strains do not belong in any groups. Explanation for this is in discussion part.

^bThe numbers of isolates with negative(-) and positive(+) results are shown.

Table 3

Distribution of ESBLs among Enterobacteriacae isolates

^a TEM-1 is not ESBL enzyme

No, Negative

Notes

This study was received a research award in the Annual Meeting of the Korean Society of Infectious Diseases and the Korean Society for Chemotherapy, 2008.

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