title: Inducible amp C beta-lactamase producing gram-negative bacilli from blood stream infections: frequency, antimicrobial susceptibility, and molecular epidemiology in a national surveillance program (SCOPE).
abstract: A surveillance study of nosocomial blood stream infections [Surveillance and Control of Pathogens of Epidemiologic Importance (SCOPE)] was conducted during a 14-month period in 1995 to 1996 in approximately 50 American medical centers. Among the 4725 blood stream infections, the etiologic agent was Enterobacter spp. in 230, Citrobacter freundii in 24, and Serratia marcescens in 65. The vast majority of these isolates (89%) had been sent to the University of Iowa including 198 Enterobacter spp. (46 Enterobacter aerogenes, 141 Enterobacter cloacae, 11 other Enterobacter spp.), 23 C. freundii, and 62 S. marcescens. Because these species are capable of producing Amp C beta-lactamase, we examined their susceptibility to 12 broad-spectrum antimicrobial agents. The frequency of resistance to ceftazidime and the molecular epidemiology of ceftazidime-resistant strains was also examined. Among the Enterobacter spp. and C. freundii isolates, resistance to third generation cephalosporins (ceftazidime, ceftriaxone) and broad-spectrum semisynthetic penicillins (piperacillin), with or without an enzyme inhibitor (piperacillin/tazobactam), was high, e.g., 35 to 50%. The S. marcescens isolates were quite susceptible to all agents tested. Both imipenem and cefepime were active against virtually all isolates tested including 84 stably derepressed Amp C-producing ceftazidime-resistant strains of Enterobacter spp. and C. freundii. The overall rank order of activity for the six best agents against these Amp C-producing strains was: imipenem (100% susceptible) > amikacin = cefepime (98.6%) > ciprofloxacin = gentamicin = ofloxacin (93.6 to 94.0%). Molecular typing studies of ceftazidime-resistant E. cloacae using an automated ribotyping system, as well as pulsed-field gel electrophoresis, indicated that although clonal spread of a single strain occurred in some of the medical centers, most of the episodes of bacteremia were caused by patient-unique strains. Control of these resistant organisms will require attention to microbiologic recognition of phenotypes, to infection control practices, and to limiting the overuse of certain extended spectrum beta-lactams.
authors.affiliation: Department of Pathology, University of Iowa College of Medicine, Iowa City 52242, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Pfaller
authors.forename: R N
authors.initials: RN
authors.lastname: Jones
authors.forename: S A
authors.initials: SA
authors.lastname: Marshall
authors.forename: S L
authors.initials: SL
authors.lastname: Coffman
authors.forename: R J
authors.initials: RJ
authors.lastname: Hollis
authors.forename: M B
authors.initials: MB
authors.lastname: Edmond
authors.forename: R P
authors.initials: RP
authors.lastname: Wenzel
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000097:blood / Q000453:epidemiology / Q000382:microbiology*; D015373:Bacterial Typing Techniques; D002442:Ceftazidime / Q000494:pharmacology; D016971:Citrobacter freundii / Q000145:classification / Q000187:drug effects / Q000201:enzymology; D003428:Cross Infection / Q000097:blood / Q000453:epidemiology / Q000382:microbiology*; D000242:Cyclic AMP / Q000378:metabolism; D003625:Data Collection; D004352:Drug Resistance, Microbial; D004754:Enterobacter / Q000145:classification / Q000187:drug effects / Q000201:enzymology; D006090:Gram-Negative Bacteria / Q000145:classification / Q000187:drug effects* / Q000201:enzymology; D016905:Gram-Negative Bacterial Infections / Q000097:blood / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D015337:Multicenter Studies as Topic; D016036:Seroepidemiologic Studies; D012706:Serratia marcescens / Q000145:classification / Q000187:drug effects / Q000201:enzymology; D014481:United States / Q000453:epidemiology; D001618:beta-Lactamases / Q000187:drug effects* / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D002442:Ceftazidime; D000242:Cyclic AMP; D001618:beta-Lactamases