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Antimicrobial Agents and Chemotherapy, January 2002, p. 196-202, Vol. 46, No. 1
0066-4804/01/$04.00+0     DOI: 10.1128/AAC.46.1.196-202.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

Occurrence of Extended-Spectrum ß-Lactamases in Members of the Family Enterobacteriaceae in Italy: Implications for Resistance to ß-Lactams and Other Antimicrobial Drugs

T. Spanu,1 F. Luzzaro,2 M. Perilli,3 G. Amicosante,3 A. Toniolo,2 G. Fadda,1* and The Italian ESBL Study Group {dagger}

Institute of Microbiology, Catholic University, Rome,1 Laboratory of Microbiology, Ospedale di Circolo and University of Insubria, Varese,2 Department of Sciences and Biomedical Technology, University of L’Aquila, L’Aquila, Italy3

Received 22 March 2001/ Returned for modification 25 July 2001/ Accepted 29 September 2001

An Italian nationwide survey was carried out to assess the prevalences and the antimicrobial susceptibilities of members of the family Enterobacteriaceae producing extended-spectrum ß-lactamases (ESBLs). Over a 6-month period, 8,015 isolates were obtained from hospitalized patients and screened for resistance to extended-spectrum cephalosporins and monobactams. On the basis of a synergistic effect between clavulanate and selected ß-lactams (ceftazidime, aztreonam, cefotaxime, cefepime, and ceftriaxone), 509 isolates were found to be ESBL positive (6.3%). Colony blot hybridization with blaTEM and blaSHV DNA probes allowed one to distinguish four different genotypes: TEM-positive, SHV-positive, TEM- and SHV-positive, and non-TEM, non-SHV ESBL types. MICs for each isolate (E-test) were obtained for widely used ß-lactams, combinations of ß-lactams with ß-lactamase inhibitors, aminoglycosides, and fluoroquinolones. Among ESBL-positive strains, Klebsiella pneumoniae, Proteus mirabilis, and Escherichia coli accounted for 73.6% of isolates. Overall, TEM-type ESBLs were more prevalent than SHV-type enzymes (234 versus 173), whereas the prevalence of strains producing both TEM- and SHV-type ESBLs was similar to that of isolates producing non-TEM, non-SHV enzymes (55 and 38, respectively). In vitro, all but one of the ESBL-producing isolates remained susceptible to imipenem. Susceptibility to other drugs varied: piperacillin-tazobactam, 91%; amoxicillin-clavulanic acid, 85%; cefoxitin, 78%; amikacin, 76%; ampicillin-sulbactam, 61%; ciprofloxacin, 58%; and gentamicin, 56%. Associated resistance to aminoglycosides and ciprofloxacin was observed most frequently among TEM-positive strains. Since therapeutic options for multiresistant Enterobacteriaceae are limited, combinations of ß-lactams and ß-lactamase inhibitors appear to represent an important alternative for treating infections caused by ESBL-producing Enterobacteriaceae.

* Corresponding author. Mailing address: Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, 00168 Roma, Italy. Phone: 39-06-305.4411. Fax: 39-06-305.1152. E-mail: ibimb{at}rm.unicatt.it.

{dagger} In addition to the authors listed, The Italian ESBL Study Group was composed of the following members: G. Fortina, Ospedale Civile, Novara; R. Vaiani, Ospedale San Raffaele, Milan; E. Magliano, Ospedale Niguarda, Milan; A. Goglio, Ospedali Riuniti, Bergamo; P. Nicoletti, Ospedale Careggi, Florence; F. Menichetti, Ospedale Monteluce, Perugia; G. Miragliotta, University of Bari, Bari; G. Nicoletti, University of Catania, Catania.

Antimicrobial Agents and Chemotherapy, January 2002, p. 196-202, Vol. 46, No. 1
0066-4804/01/$04.00+0     DOI: 10.1128/AAC.46.1.196-202.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.



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