title: Rapid emergence of ciprofloxacin-resistant enterobacteriaceae containing multiple gentamicin resistance-associated integrons in a Dutch hospital.
abstract: In a hematology unit in the Netherlands, the incidence of ciprofloxacin-resistant Enterobacter cloacae and Escherichia coli increased from from 1996 to 1999. Clonal spread of single genotypes of both ciprofloxacin-resistant E. coli and Enterobacter cloacae from patient to patient was documented by pulsed-field gel electrophoresis and random amplification of polymorphic DNA. In addition, genetically heterogeneous strains were isolated regularly. Integrons associated with gentamicin resistance were detected in Enterobacter cloacae and E. coli strains. Integron-containing E. coli were detected in all hematology wards. In contrast, in Enterobacter cloacae strains two integron types were encountered only in the isolates from one ward. Although in all patients identical antibiotic regimens were used for selective decontamination, we documented clear differences with respect to the nosocomial emergence of ciprofloxacin-resistant bacterial strains and gentamicin resistance-associated integrons.
authors.affiliation: Eramus University Medical Center Rotterdam, The Netherlands. vanbelkum@bacl.azr.nl
authors.forename: A
authors.initials: A
authors.lastname: van Belkum
authors.forename: W
authors.initials: W
authors.lastname: Goessens
authors.forename: C
authors.initials: C
authors.lastname: van der Schee
authors.forename: N
authors.initials: N
authors.lastname: Lemmens-den Toom
authors.forename: M C
authors.initials: MC
authors.lastname: Vos
authors.forename: J
authors.initials: J
authors.lastname: Cornelissen
authors.forename: E
authors.initials: E
authors.lastname: Lugtenburg
authors.forename: S
authors.initials: S
authors.lastname: de Marie
authors.forename: H
authors.initials: H
authors.lastname: Verbrugh
authors.forename: B
authors.initials: B
authors.lastname: Löwenberg
authors.forename: H
authors.initials: H
authors.lastname: Endtz
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D000890:Anti-Infective Agents / Q000494:pharmacology*; D002939:Ciprofloxacin / Q000494:pharmacology*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D016972:Enterobacter cloacae / Q000145:classification / Q000187:drug effects / Q000235:genetics; D004755:Enterobacteriaceae / Q000145:classification / Q000187:drug effects* / Q000235:genetics; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000382:microbiology; D004926:Escherichia coli / Q000145:classification / Q000187:drug effects / Q000235:genetics; D005839:Gentamicins / Q000494:pharmacology*; D006405:Hematology; D006757:Hospital Units; D006801:Humans; D019426:Integrases / Q000235:genetics*; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D019105:Random Amplified Polymorphic DNA Technique
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D005839:Gentamicins; D002939:Ciprofloxacin; D019426:Integrases; C115006:integron integrase IntI1