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Antimicrobial Agents and Chemotherapy, May 2004, p. 1520-1525, Vol. 48, No. 5
0066-4804/04/$08.00+0     DOI: 10.1128/AAC.48.5.1520-1525.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Variety of ß-Lactamases Produced by Amoxicillin-Clavulanate-Resistant Escherichia coli Isolated in the Northeastern United States

Keith S. Kaye,1* Howard S. Gold,1 Mitchell J. Schwaber,1 Lata Venkataraman,1 Youlin Qi,1 Paola C. De Girolami,1 Matthew H. Samore,2 Greg Anderson,3 J. Kamile Rasheed,3 and Fred C. Tenover3

Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215,1 University of Utah, Salt Lake City, Utah 84132,2 Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 303333

Received 5 September 2003/ Returned for modification 20 November 2003/ Accepted 27 January 2004

This study analyzed the enzymatic basis and molecular epidemiology of amoxicillin-clavulanate-resistant Escherichia coli isolated by the microbiology laboratory of a United States tertiary care hospital. From October 1998 to December 1999, all E. coli isolates were screened for ampicillin-sulbactam resistance. Of 283 isolates that tested resistant to ampicillin-sulbactam, 69 unique patient isolates were also resistant to amoxicillin-clavulanate by disk diffusion testing (zone diameter <= 13 mm). These amoxicillin-clavulanate-resistant E. coli isolates underwent agar dilution testing, pulsed-field gel electrophoresis, PCR analysis, and isoelectric focusing. The mean age of study patients was 52 years; 78% were female. Among the isolates, 12 were nosocomial (rate of amoxicillin-clavulanate resistance = 4.7%) and 57 were community acquired (rate of amoxicillin-clavulanate resistance = 2.8%). No predominant strain was identified. By agar dilution testing, 67 isolates were nonsusceptible (39 resistant and 28 intermediate) to amoxicillin-clavulanate and 37 were piperacillin-tazobactam resistant but only 8 were ceftazidime resistant (ceftazidime MIC >= 32 µg/ml). Two isolates were susceptible to amoxicillin-clavulanic acid by agar dilution, although they were resistant by disk diffusion testing. The distribution of ß-lactamases was as follows: the TEM type alone was found in 52 isolates, the AmpC type was found in 4 isolates (2 identified as containing CMY-2), the TEM type and CMY-2 were found in 2 isolates, and the OXA type was found in 1 isolate. Also, there was one isolate with the TEM type and the SHV type and one with the TEM type and a second, unidentified enzyme. Among the isolates with TEM-type enzymes, two extended-spectrum ß-lactamase-producing isolates were identified but two isolates with inhibitor-resistant TEM (IRT) enzymes (one with TEM-34 [IRT-6] and the other with a novel enzyme [tentatively assigned the designation TEM-122]) were more interesting.

* Corresponding author. Mailing address: Duke University Medical Center, Department of Medicine, Division of Infectious Diseases, Box 3152, Durham, NC 27710. Phone: (919) 668-1720. Fax: (919) 684-3137. E-mail: Kaye0001{at}mc.duke.edu.

Antimicrobial Agents and Chemotherapy, May 2004, p. 1520-1525, Vol. 48, No. 5
0066-4804/04/$08.00+0     DOI: 10.1128/AAC.48.5.1520-1525.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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