AAC Accepts, published online ahead of print on 27 May 2008

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Antimicrob. Agents Chemother. doi:10.1128/AAC.00171-08
Copyright (c) 2008, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights Reserved.

Molecular characterization and epidemiology of extended-spectrum -lactamase-producing Escherichia coli and Klebsiella pneumoniae causing healthcare-associated infection in Thailand: An endemic area of CTX-M

Pattarachai Kiratisin^*, Anucha Apisarnthanarak, Chaitat Laesripa, and Piyawan Saifon

Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, 10700; Division of Infectious Diseases, Faculty of Medicine, Thammasart University Hospital, Pratumthani, Thailand, 12120

^* To whom correspondence should be addressed. Email: sipkr{at}mahidol.ac.th.

Extended-spectrum -lactamase-producing Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP) have rapidly spread worldwide and cause a serious threat for healthcare-associated (HA) infection. We conducted molecular detection and characterization of ESBL-related bla genes including bla_TEM, bla_SHV, bla_CTX-M, bla_VEB, bla_OXA, bla_PER and bla_GES among 362 isolates of ESBL-EC (n = 235) and ESBL-KP (n = 127) collected from patients who met the definition of HA infection at two major university hospitals in Thailand during December 2004-May 2005. Prevalence of ESBL-EC and ESBL-KP, patient demographics and susceptibility of these bacteria to various antimicrobial agents were described. 87.3% of isolates carried several bla genes. The prevalence of bla_CTX-M was strikingly high; 99.6% for ESBL-EC (CTX-M-14, -15, -27, -40 and -55) and 99.2% for ESBL-KP (CTX-M-3, -14, -15, -27 and -55). The ISEcp1 was found in the upstream region of bla_CTX-M in most isolates. Up to 77.0% and 71.7% of ESBL-EC and ESBL-KP, respectively, carried bla_TEM; all of them encoded for TEM-1. ESBL-KP carried bla_SHV at 87.4% (SHV-1, -2a, -11, -12, -27, -71 and -75), while only at 3.8% for ESBL-EC (SHV-11 and -12). bla genes encoding for VEB-1 and OXA-10 were found in both ESBL-EC (8.5% and 8.1%, respectively) and ESBL-KP (10.2% and 11.8%, respectively). None of isolates were positive for bla_PER and bla_GES. Pulsed-field gel electrophoresis analysis demonstrated that there was no major clonal relationship among these ESBL producers. This is the first study to report CTX-M-3, CTX-M-27, CTX-M-40, SHV-27, SHV-71 and SHV-75 in Thailand and show that CTX-M ESBL is highly endemic in this country.

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