Annals of Clinical Microbiology, The official Journal of the Korean Society of Clinical Microbiology

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Indexed in KCI, KoreaMed, Synapse, DOAJ
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pISSN 2288-0585 eISSN 2288-6850

Prevalence of Extended-spectrum β-lactamase-producing Enterobacteriaceae and Evaluation of Methods for Detection

Original article

Annals of Clinical Microbiology (Ann Clin Microbiol) 1999 June Volume 2, Issue 1, pages 28-39.

Prevalence of Extended-spectrum β-lactamase-producing Enterobacteriaceae and Evaluation of Methods for Detection

Byung Lip Kim*, M.D., Seok Hoon Jeong, M.D., Ja Young Koo*, M.D., Kyungwon Lee**, M.D., Yunsop Chong**, Ph.D., Tae Jeon Jeong, M.T., Hyun Yong Hwang, M.D. and Mi Hyang Kim, M.D.

Department of Internal Medicine* and Clinical Pathology, College of Medicine Kosin University, Pusan, and Department of Clinical Pathology, College of Medicine Yonsei University, Seoul, Korea**

Abstract

Background : Increased isolation of extended-spectrum β-lactamase ( ESBL)-producing Enterobacteriaceae resistant to third generation cephalosporins and aztreonam has been noted recently. This study was to determine the prevalence of resistance to these drugs and ESBL in Enterobacteriaceae and to evaluate the methods for detection.

Methods:During the period of October, 1997 and March, 1998, a total of 731 clinical isolates of Enterobacteriaceae were collected from patients of the Kosin Medical Center, Pusan, Korea. Antimicrobial susceptibility test by disk diffusion method and double disk synergy test were performed. MICs of β-lactams were determined by agar dilution method. And ESBL genotypes were determined by polymerase chain reaction.

Results:About 10% of Escherichia coli isolates and 20% of Klebsiella pneumoniae isolates were intermediate or resistant to the third generation cephalosporins or aztreonam. Sensitivities of cefotaxime, ceftazidime, ceftriaxone and cefpodoxime disks for the detection of ESBL- producing strains of E. coli and K. pneumoniae by NCCLS standards were 100%, respectively, but that of aztreonam disk was 97%. Positive predictive value of the ceftazidime disk was higher than those of other disks. Twenty strains of E. coli, 20 K. pneumoniae, 19 Enterobacter spp., six Citrobacter freundii, and eight Serratia marcescens showed positive results in double disk synergy test. The transconjugant strain of K. pneumoniae K20482 had blaSHV, and remains of transconjugants of ESBL-producing K. pneumoniae, Enterobacter spp. and S. marcescens had blaTEM.

Conclusions:In this study, many strains of Enterobacteriaceae isolated in Korea were resistant to third generation cephalosporins and aztreonam. Some of the strains of Enterobacter spp. and S. marcescens as well as E. coli and K. pneumoniae produced ESBL, and majority of these strains had blaTEM. In the detection of ESBL-producing strains of E. coli and K. pneumoniae by NCCLS standards, all of the antimicrobial agent disks tested were useful, but ceftazidime disk was most effective because of its highest positive predictive value. (Korean J Clin Microbiol 1999;2:28~39)

Keywords

Enterobacteriaceae, Extended-spectrum β-lactamase, TEM, SHV, Third generation cephalosporins, Aztreonam