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Antimicrobial Agents and Chemotherapy, July 2008, p. 2449-2454, Vol. 52, No. 7
0066-4804/08/$08.00+0     doi:10.1128/AAC.00043-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Molecular Survey of β-Lactamases Conferring Resistance to Newer β-Lactams in Enterobacteriaceae Isolates from Polish Hospitals

Joanna Empel, Anna Baraniak, Elbieta Literacka, Agnieszka Mrówka, Janusz Fiett, Ewa Sadowy, Waleria Hryniewicz, Marek Gniadkowski,^* and the Beta-PL Study Group

National Medicines Institute, 00-725 Warsaw, Poland

Received 11 January 2008/ Returned for modification 23 March 2008/ Accepted 25 April 2008

The first national survey of resistance to newer β-lactams in nosocomial populations of Enterobacteriaceae in Poland was performed. The study covered all nonrepetitive enterobacterial isolates cultured from specimens from inpatients in 13 regional secondary-care hospitals from November 2003 to January 2004. Among 2,388 isolates, the predominant species was Escherichia coli (59.6%), followed by Proteus mirabilis (14.5%) and Klebsiella spp. (8.5%). The frequency of extended-spectrum β-lactamases (ESBLs) was very high, with ESBLs present in 11.1% of all isolates and 40.4% of Klebsiella pneumoniae isolates, the latter value greatly exceeding that for E. coli (2.5%). The contribution of outbreak isolates was significant, resulting, for example, in a particularly high rate of ESBL producers among Serratia marcescens isolates (70.8%). The pool of ESBL types was overwhelmingly dominated (81.7%) by CTX-M-like β-lactamases CTX-M-3 (80.6%) and CTX-M-15, with SHV types (17.5%; SHV-2, SHV-5, and SHV-12) and sporadic TEM-like enzymes (0.7%; TEM-19 and TEM-48) being the next most frequent. Acquired AmpC-type cephalosporinases were observed exclusively in P. mirabilis, in 20.5% of the isolates of this species (compared with the frequency of ESBL producers of 11.5% of P. mirabilis isolates). All these cephalosporinases (CMY-12, CMY-15, and a novel variant, CMY-38) originated from Citrobacter freundii. Four isolates of E. coli (two isolates), K. pneumoniae (one isolate), and P. mirabilis (one isolate) produced class A inhibitor-resistant β-lactamases (TEM-30, TEM-32, TEM-37, and SHV-49), being the first of such producers identified in Poland. The survey documented both specific and more global characteristics of the epidemiology of the β-lactamase-mediated resistance in enterobacteria from Polish hospitals and demonstrated that the ESBL frequency has reached an alarming level.

Published ahead of print on 5 May 2008.

These authors contributed equally to this work.

In addition to the authors listed, the Beta-PL Study Group included the following members: J. Bakiera, Voivodship Specialist Hospital, Lublin, Poland; A. Budak, Kraków Specialist Hospital, Kraków, Poland; K. Burdynowski, Voivodship Medical Center, Opole, Poland; K. Golec, Voivodship Hospital No. 2, Rzeszów, Poland; E. Jaworska-Bach, Voivodship Specialist Hospital, Wrocaw, Poland; J. Kochanowska, Voivodship Hospital, Bydgoszcz, Poland; A. Powarzyska, Voivodship Hospital No. 2, Gorzów Wielkopolski, Poland; B. Ruszel, Voivodship Hospital, Koszalin, Poland; E. Sobolewska, Copernicus Specialist Hospital, £ód, Poland; D. Stankiewicz, Bródno Voivodship Hospital, Warsaw, Poland; M. Szarata, Voivodship Hospital, Pozna, Poland; G. Ziókowski, St. Barbara Voivodship Specialist Hospital, Sosnowiec, Poland; B. aglewska, St. Adalbert Specialist Hospital, Gdask, Poland; and W. ulikowski, Voivodship Hospital, £oma, Poland.