Antibiotic resistance rates and phenotypes among isolates of Enterobacteriaceae in French extra-hospital practice.
Antibiotic resistance among members of the family Enterobacteriaceae was prospectively surveyed by eight French private laboratories over a 5-month period in 1999. A total of 2,599 consecutive and nonduplicate strains were collected, mainly (60.9%) from patients in the community. Most strains (82.9%) derived from urine. Escherichia coli was the predominant (73.9%) organism isolated. The overall rates of antibiotic resistance were as follows: amoxicillin, 53.4%; amoxicillin-clavulanic acid, 27.3%; ticarcillin, 44.2%; piperacillin-tazobactam, 3.2%; cephalothin, 29.2%; cefuroxime, 14.7%; cefoxitin, 11.5%; ceftazidime, 3.6%; cefotaxime, 2.8%; cefepime, 0.3%; imipenem, 0.1%; gentamicin (G), 3.8%; tobramycin (T), 5.0%; netilmicin (Nt), 3.7%; amikacin (A), 0.7%; nalidixic acid, 14.3%; ofloxacin, 10.4%; cotrimoxazole, 21.1%; nitrofurantoin, 12.7%; fosfomycin, 5.2%; tetracycline, 50.1%; and colistin, 12.5%. Beta-lactam resistance phenotypes essentially comprised penicillinase production (33.9%), overexpression of chromosomal cephalosporinase (4.6%), and synthesis of inhibitor-resistant TEM/OXA enzymes (1.5%) or extended-spectrum beta-lactamases (1.5%). Aminoglycoside resistance phenotypes consisted of GTNt (93 strains), TNtA (68 strains), GTNtA (14 strains), T (4 strains), GT (3 strains), G (1 strain), and reduced uptake/permeability (3 strains). Most of the nalidixic acid-resistant strains were resistant to ofloxacin (72.8%). Antibiotic resistance rates and phenotypes varied widely according to the bacterial group and the source of the strains. Significantly higher rates were observed in private healthcare centers than in the community, due to a higher proportion of both resistant species and resistant strains. However, multidrug-resistant isolates, including five extended-spectrum beta-lactamase-producing strains, were also recovered from the community.
Laboratoire de Microbiologie, Faculté de Pharmacie, Université de Bordeaux 2, 146 rue Léo Saignat, 33076 Bordeaux Cedex, France. claudine.quentin@bacterio.u-bordeaux2.fr
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Quentin
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Arpin
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Dubois
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André
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Lagrange
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Fischer
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JP
Brochet
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Grobost
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Jullin
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Dutilh
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Larribet
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Noury
D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000145:classification / Q000187:drug effects* / Q000235:genetics*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology; D005602:France / Q000453:epidemiology; D006801:Humans; D007755:Laboratories, Hospital; D008826:Microbial Sensitivity Tests; D015337:Multicenter Studies as Topic; D010597:Pharmacogenetics; D010641:Phenotype; D011159:Population Surveillance; D011446:Prospective Studies; D012680:Sensitivity and Specificity
D000900:Anti-Bacterial Agents