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Antimicrobial Agents and Chemotherapy, November 2003, p. 3506-3514, Vol. 47, No. 11
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.11.3506-3514.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Extended-Spectrum ß-Lactamase-Producing Enterobacteriaceae in Community and Private Health Care Centers

Corinne Arpin,1* Véronique Dubois,1 Laure Coulange,1 Catherine André,1 Isabelle Fischer,2 Patrick Noury,3 Frédéric Grobost,4 Jean-Philippe Brochet,2 Jacqueline Jullin,2 Brigitte Dutilh,2 Gilberte Larribet,5 Isabelle Lagrange,6 and Claudine Quentin1

Laboratoire de Microbiologie, Université de Bordeaux 2, 33076 Bordeaux Cedex,1 Laboratoires d'Analyses Médicales, 33000 Bordeaux,2 Laboratoire d'Analyses Médicales, 64000 Bayonne,4 Laboratoire d'Analyses Médicales, 33160 St Médard-en-Jalles,5 Laboratoire d'Analyses Médicales, 33140 Villenave d'Ornon,3 Laboratoire d’Analyses Médicales, 16000 Angouleme, France6

Received 27 March 2003/ Returned for modification 15 May 2003/ Accepted 23 July 2003

In 1999, 39 of 2,599 isolates of the family Enterobacteriaceae (1.5%) collected by eight private laboratories in the Aquitaine region in France produced an extended-spectrum ß-lactamase (ESBL). Among these were 19 Enterobacter aerogenes isolates; 8 Klebsiella pneumoniae isolates; 6 Escherichia coli isolates; 3 Proteus mirabilis isolates; and 1 isolate each of Serratia marcescens, Morganella morganii, and Providencia stuartii. ESBL producers were isolated from 38 patients, including 33 residents of 11 clinics or nursing homes and 5 ambulatory patients. Seven different ESBLs were characterized. These mainly consisted of TEM-24 (25 isolates) and TEM-21 (9 isolates), but TEM-15 (2 isolates) and TEM-3, TEM-19, SHV-4, and CTX-M-1 (1 isolate each) were also characterized. Seven strains showed the coexistence of different TEM- and/or SHV-encoding genes, including a new SHV-1 variant, SHV-44, defined by the substitution R205L previously reported for SHV-3 in association with S238G. The epidemiology of the ESBL producers was investigated by random amplification of polymorphic DNA, typing by enterobacterial repetitive intergenic consensus PCR, analysis of resistance cotransferred with the ESBL, and analysis of the restriction profiles of the ESBL-encoding plasmids. Of the TEM-24-expressing strains, 18 were E. aerogenes isolates, including 9 from the same clinic, that were representatives of the epidemic clone disseminating in France. Of the TEM-21-producing strains that belonged to different species of the family Enterobacteriaceae (E. coli, K. pneumoniae, and P. mirabilis), 8 were isolated in the same nursing home. Outbreaks due to strain and/or plasmid dissemination in these clinic and nursing home were demonstrated. The presence of ESBL producers in five ambulatory patients probably resulted from nosocomial acquisition. Our data highlight the serious need to monitor patients for ESBL-producing Enterobacteriaceae in general practice.

* Corresponding author. Mailing address: Laboratoire de Microbiologie, Faculté de Pharmacie, Université de Bordeaux 2, 146 rue Léo Saignat, 33076 Bordeaux Cedex, France. Phone: (33) 5 57 57 10 75. Fax: (33) 5 56 90 90 72. E-mail: corinne.arpin{at}bacterio.u-bordeaux2.fr.

Antimicrobial Agents and Chemotherapy, November 2003, p. 3506-3514, Vol. 47, No. 11
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.11.3506-3514.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.



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