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Mechanisms of Resistance

Molecular Characterization of Cefoxitin-Resistant Escherichia coli from Canadian Hospitals

Michael R. Mulvey, Elizabeth Bryce, David A. Boyd, Marianna Ofner-Agostini, Allison M. Land, Andrew E. Simor, Shirley Paton, ; the Canadian Hospital Epidemiology Committee, ; the Canadian Nosocomial Infection Surveillance Program, Health Canada
Michael R. Mulvey
1Nosocomial Infections, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba
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  • For correspondence: michael_mulvey@hc-sc.gc.ca
Elizabeth Bryce
2The Vancouver General Hospital, Vancouver, British Columbia
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David A. Boyd
1Nosocomial Infections, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba
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Marianna Ofner-Agostini
3The University of Toronto
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Allison M. Land
1Nosocomial Infections, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba
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Andrew E. Simor
4The Department of Microbiology, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
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Shirley Paton
5Division of Nosocomial and Occupational Infections, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario
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DOI: 10.1128/AAC.49.1.358-365.2005
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  • FIG. 1.
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    FIG. 1.

    Number of cefoxitin-resistant strains isolated by month and by site over the length of the study. Colors represent the total number of strains at a specific site.

  • FIG. 2.
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    FIG. 2.

    Dendrogram depicting DNA macrorestriction patterns of cefoxitin-resistant E. coli strains generated with XbaI. The shaded region highlights the largest outbreak cluster described in the text.

  • FIG. 3.
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    FIG. 3.

    Schematic diagram showing the insertion of the IS10 (two strains) and IS911-like (one strain) elements in the ampC promoter region, as found in this study.

Tables

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  • TABLE 1.

    Site of isolation of cefoxitin-resistant strains

    Site of isolationNo. of E. coli isolates froma:
    MalesFemales
    Blood (n = 18)135
    Wound (n = 12)111
    Abscess (n = 1)10
    Urine or urinary tract (n = 162)61101
    Upper respiratory tract (n = 7)52
    Lower respiratory tract (n = 3)21
    Other (n = 6)42
        Total97112
    • ↵ a A total of 209 cefoxitin-resistant E. coli isolates recovered from 232 reported sites of isolation.

  • TABLE 2.

    Antimicrobial resistance patterns of study strainsa

    Antimicrobial agent% (no.) of resistant strainsb
    AmpC producers (n = 232)Non-AmpC producers (n = 183)
    Amoxicillin-clavulanate66 (152)43 (79)
    Ampicillin96 (223)82 (150)
    Cefazolin55 (127)36 (65)
    Ceftazidime1.3 (3)1.1 (2)
    Ceftriaxone2.1 (5)11 (21)
    Piperacillin-tazobactam4.7 (11)2.2 (4)
    Cefotetan0 (0)0 (0)
    Imipenem0 (0)0 (0)
    Ciprofloxacin45 (105)19 (35)
    Levofloxacin44 (102)19 (34)
    Nitrofurantoin7.3 (17)1.6 (3)
    Gentamicin27 (63)25 (45)
    Amikacin1.3 (3)2.2 (4)
    Tobramycin26 (60)18 (33)
    Trimethoprim-sulfamethoxazole51 (118)33 (60)
    • ↵ a As determined with Vitek GNS 121 cards.

    • ↵ b Cefoxitin MICs were ≥32 μg/ml for AmpC producers and <32 μg/ml for non-AmpC producers, as determined by broth microdilution.

  • TABLE 3.

    Mutations at given positions in ampC promoter region for specific promoter typesa

    Embedded Image
    • ↵ a Position numbering as defined by Jaurin et al. (13). Type numbers were assigned arbitrarily. WT, wild-type promoter from E. coli K-12; DEL, deletion at the indicated position.

    • b Positions −42, −18, and −15 are involved in the alternate promoter; positions −32 and −11 are part of the wild-type promoter; positions −13.1 and −13.2 are part of the spacer region of the wild-type promoter; nucleotides between positions +17 and +37 are located in the attenuator; and positions +63, +70, and +81 are located in the coding region.

  • TABLE 4.

    Promoter sequence types of strains containing CMY-2 gene

    Promoter sequence typeNo. of strainsNo. of strains with CMY-2
    Wild type147
    03361
    04191
    0785
    11102
    1711
    18125
    2211
    4811
    5211
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Molecular Characterization of Cefoxitin-Resistant Escherichia coli from Canadian Hospitals
Michael R. Mulvey, Elizabeth Bryce, David A. Boyd, Marianna Ofner-Agostini, Allison M. Land, Andrew E. Simor, Shirley Paton the Canadian Hospital Epidemiology Committee, the Canadian Nosocomial Infection Surveillance Program, Health Canada
Antimicrobial Agents and Chemotherapy Dec 2004, 49 (1) 358-365; DOI: 10.1128/AAC.49.1.358-365.2005

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Molecular Characterization of Cefoxitin-Resistant Escherichia coli from Canadian Hospitals
Michael R. Mulvey, Elizabeth Bryce, David A. Boyd, Marianna Ofner-Agostini, Allison M. Land, Andrew E. Simor, Shirley Paton the Canadian Hospital Epidemiology Committee, the Canadian Nosocomial Infection Surveillance Program, Health Canada
Antimicrobial Agents and Chemotherapy Dec 2004, 49 (1) 358-365; DOI: 10.1128/AAC.49.1.358-365.2005
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KEYWORDS

Anti-Bacterial Agents
cefoxitin
Cephalosporin Resistance
Escherichia coli
Escherichia coli Infections
Hospitals

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