TABLE 2.

Epidemiological features (clinical, clonal, plasmid, and integron data) of CTX-M-9-producing Enterobacteriaceae isolates at the Ramón y Cajal Hospital shown in relation to plasmid types (1996 to 2003)

Plasmid Inc groupaApproximate plasmid size (kb)bReplicon type by PCRcTypedSubtypedIsolateeNo. of patientsSpeciesWardfSpecimen sourceE. coli phylogenetic groupDate (mo/yr)Presence ofg:Antibiotic resistanceh
IS26merA
P-1α100 P , I1, FIBIn60-A1 D47 1i E. coli OutpatientWoundA3/02++Sm, Su, Tp, Te
P-1α100 P , I1, FIBIn60-A1 D72 1i E. coli Int. Med.Rectal swabB24/02+Sm, Su, Tp, Te, Cm, Na, Ak
P-1α100 P , I1In60-A1 D80 1 E. coli NephrologyUrineB15/02+Sm, Su, Tp, Te, Km
P-1α100 P , I1, FIB, FIn60-A1F181 E. coli Gastroent.UrineD10/02++Sm, Su, Tp, Te, Na, Ak
P-1α100 P In60-A3 EC40 1 E. coli UrologyUrineA6/98+ Sm , Su, Tp, Te, Na
P-1α100 P , I1, FIB, FIn60-A4 F5 1 E. coli OutpatientBloodA9/02++Sm, Su, Tp, Te, Na, Gm, Ak
P-1α100 P , I1In60-A4 G34 1 K. pneumoniae OutpatientUrine6/03+ Sm , Su, Tp, Te, Km
P-1α100 P , I1In60-B3 C77 1 E. coli OutpatientUrineA9/01+Sm, Su, Tp, Te
P-1α100 P , I1, FIBIn60-B3 E27 1 E. coli OutpatientUrineB25/02+Sm, Su, Tp, Te
P-1α100 P , I1, FIB, FIn60-B4 EC72 1 E. coli NephrologyWoundA10/00++ Sm , Tb, Su, Tp, Te, Cp, Na, Km, Gm
I1120jI1In60-A5 EC44 1 E. coli DermatologyUrineA1/99++ Sm , Su, Tp, Te, Cp, Na
HI2280 HI2 , FIB, FIn60-A1EC281 E. coli NephrologyBloodB110/97+ Sm , Su, Tp, Te, Cm, Cp, Na
HI2280 HI2 , FIB, FIn60-A1 EC76 1 E. coli OutpatientUrineA12/00+ Sm , Su, Tp, Te, Cm, Cp, Na
HI2280 HI2 , FIB, FIn60-A1D41 E. coli OutpatientUrineB110/01+ Sm , Su, Tp, Te, Cp, Na
HI2, F1320 HI2 , FIBIn60-A1 D36 1 E. coli Gastroent.BloodB23/02+Sm, Su, Tp, Na, Cp, Km
HI2320 HI2 , FIBIn60-A2 EC29 1 E. coli UrologyUrineB23/97++ Sm , Su, Tp, Te, Cm, Na
HI2270 HI2 In60-A2 EC63 1 E. coli UrologyUrineA4/00++ Sm , Su, Tp, Te, Cp, Na
HI2290 HI2 In60-A2 EC62 1 E. coli NephrologyUrineA4/00+ Sm , Su, Tp, Te, Cp
HI2280 HI2 In60-A2 EC68 1 E. coli Surgery ICUDrainageB17/00++ Sm , Su, Tp, Te, Cp, Na
HI2260 HI2 , FIB, FIn60-A3EC252 E. coli Surgery ICURespiratoryD10/96++Sm, Su, Tp, Te, Cp, Na, Km
UrologyUrine12/96
HI2280 HI2 , FIn60-A4 EC24 1 E. coli UrologyUrineA10/96+ Sm , Su, Tp, Te, Cm, Na, Km
HI2260 HI2 , I1In60-A4 EC57 1 E. coli Neurosurg. ICURespiratoryA2/00+ Sm , Su, Tp, Te, Cp, Na, Gm, Km, Tb
HI2280 HI2 , FIB, FIn60-A4EC391 E. coli Neurosurg. ICUCatheterD2/98++Sm, Su, Tp, Te
HI2280 HI2 , FIBIn60-A4 EC41 1 E. coli OutpatientUrineA12/98++ Sm , Su, Tp, Te
HI2280 HI2 , FIBIn60-A4 EC46 1 E. coli OutpatientUrineA3/99+Sm, Tb, Su, Tp, Te, Cm, Cp, Na, Km, Gm
HI2280 HI2 , FIB, FIn60-A4EC421 E. coli OutpatientBloodD8/99+Sm, Su, Tp, Na
HI2, F1330j HI2 , FIBIn60-A4 EC66 1 E. coli OutpatientUrineB25/00+ Sm , Su, Tp, Te, Cm, Na
HI2290 HI2 , YIn60-A4 D7 1 E. coli UrologyUrineB111/01+ Sm , Su, Tp, Te, Cm, Cp, Na, Gm
HI2290 HI2 In60-A4F251 E. cloacae OutpatientUrine10/02+Sm, Su, Tp, Te
HI2NDkHI2, FIBIn60-A4F341 E. coli NephrologyUrineB111/02+Su, Tp, Te
HI2280 HI2 In60-A4 F38 1 E. coli NephrologyWoundB212/02+Sm, Su, Tp, Te
HI2310 HI2 In60-A4 H65 1 S. enterica HematologyRectal swabs6/03+ Sm , Su, Tp, Te, Na
HI2280 HI2 , FIA, FIBIn60-A6EC691 E. coli OutpatientUrineD8/00+Sm, Su, Tp, Te, Cp, Na
HI2290 HI2 In60-C1 EC34 1 E. coli NephrologyUrineD12/97++ Sm , Su, Tp, Te, Cp, Na
HI2290 HI2 , YIn60-C2 EC33 1 E. coli Gastroent.PeritonealD11/97++Sm, Su, Tp, Te, Cm, Cp, Km, Na, Gm, Tb
HI2260 HI2 , YIn60-E4 EC50 1 E. coli UrologyUrineA12/99+ Sm
HI2240 HI2 , FIB, FIn60-F4D611 E. coli NephrologyUrineB24/02+Su, Te, Na
FIB150 FIB , FIn60-A1 C45 1 E. coli OutpatientBloodB11/01+ Sm , Su, Tp, Te, Cp, Na
FIB140 FIB , FIn60-A1 D10 1 E. coli CV surgeryWoundA11/01+ Sm , Su, Tp, Te, Na
FIB160 FIB , FIn60-C7D791 E. coli OutpatientUrineD5/02+Sm, Su, Tp, Te, Cp, Na, Gm, Tb
FIB160 FIB , FIn60-D8 E79 1 E. coli UrologyUrineD8/02+Sm, Su, Tp, Te, Na, Ak, Gm, Km, Tb
NIl70Y, B/OIn60-A1 C59 1 E. coli OutpatientUrineA4/01+Su, Tp, Te, Cp, Na, Gm, Km, Tb
NINDB/OIn60-A1 D34 1 E. coli OutpatientUrineD3/02++ Sm , Su, Tp, Te, Cm, Cp, Na
NI120YIn60-A4 EC99 1 E. coli OutpatientRectal swabsD5/02+ Sm , Su, Tp, Te, Cp, Na, Km
NI120In60-B3 Kp40 1 K. pneumoniae Gastroent.Wound11/99++ Sm , Su, Tp, Te, Cp, Na, Km
  • a Incompatibility group of plasmids harboring blaCTX-M-9 determined by PCR, hybridization, and in some cases, sequencing of the replicon.

  • b Plasmid size determined by hybridization of I-Ceu-I- or S1 nuclease-digested genomic DNA of E. coli BM21R transconjugants (or wild type if failed transfer) with an intragenic blaCTX-M-9 probe.

  • c Replicons hybridizing in the same band as that of blaCTX-M-9 are underlined.

  • d Types and subtypes of the blaCTX-M-9 integron were defined in Fig. 1.

  • e Transferability of blaCTX-M-9 is indicated by underlining.

  • f Int. Med., Internal medicine; Gastroent., gastroenterology; ICU, intensive care unit; Neurosurg., neurosurgery; CV, cardiovascular surgery.

  • g +, present; −, absent.

  • h Antibiotic resistance profile corresponding to the original strain; antibiotic resistance patterns of transconjugants are underlined. Chloramphenicol, nalidixic acid, and ciprofloxacin were not tested in the transconjugants. Sm, streptomycin; Gm, gentamicin; Tb, tobramycin; Km, kanamycin; Ak, amikacin; Su, sulfonamide; Tp, trimethoprim; Te, tetracycline; Cp, ciprofloxacin; Na, nalidixic acid; Cm, chloramphenicol.

  • i Isolates recovered from the same patient.

  • j Chromosomal location of blaCTX-M-9.

  • j ND, not determined since DNA extraction repeatedly failed.

  • j NI, not identified.