title: Integron-mediated ESBL resistance in rare serotypes of Escherichia coli causing infections in an elderly population of Israel.
abstract: OBJECTIVE
  To identify and characterize the aetiology of an outbreak of extra-intestinal multidrug-resistant Escherichia coli infections in elderly patients in Israel.
  
  
  METHODS
  Extended-spectrum beta-lactamase (ESBL)-producing clinical isolates of E. coli from extra-intestinal sources were tested for susceptibility to non-beta-lactam drugs, and their serotypes were determined. Restriction enzyme digestion, followed by PFGE of DNA purified from isolates, was used to classify the phylogenetic relationship between them. Plasmid DNA from five isolates of different serotypes was used to transform an E. coli laboratory strain. The plasmids were partially sequenced.
  
  
  RESULTS
  E. coli isolates from 86 patients, mostly elderly, were shown to be positive for inhibitor-susceptible ESBLs, and more resistant to cefotaxime than to ceftazidime. Ninety-six per cent of ESBL producers were also resistant to gentamicin, and 100% to trimethoprim/sulfamethoxazole and ciprofloxacin. All isolates belonged to one of five serotypes. PFGE analysis of purified DNA yielded 17 profiles. Sequencing of plasmids isolated from the transformants identified sul1, aac(6')-Ib and bla(CTX-M-2). These genes were embedded in an integron, InS21.
  
  
  CONCLUSIONS
  Extra-intestinal infections with ESBL-producing E. coli of different serotypes and probably mixed clonality showed a surprising homogeneity in resistance profiles, with 100% being co-resistant to ciprofloxacin and trimethoprim/sulfamethoxazole, and 96% to gentamicin. Plasmid DNA from three isolates from different serotypes contained integron InS21, previously demonstrated in Salmonella enterica from Argentina. This is the first molecular identification of an ESBL gene and integron in Israel or neighbouring geographical areas.
authors.affiliation: Faculty of Life Sciences, Bar Ilan University, Ramat Gan 52900; Microbiology Laboratory, Ma'aynei-Hayeshua Hospital, Bnei Brak; Ministry of Health Central Laboratories, Jerusalem, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Sompolinsky
authors.forename: Yeshayahu
authors.initials: Y
authors.lastname: Nitzan
authors.forename: Shaul
authors.initials: S
authors.lastname: Tetry
authors.forename: Moshe
authors.initials: M
authors.lastname: Wolk
authors.forename: Israel
authors.initials: I
authors.lastname: Vulikh
authors.forename: Mette Barendorff
authors.initials: MB
authors.lastname: Kerrn
authors.forename: Dorthe
authors.initials: D
authors.lastname: Sandvang
authors.forename: Gitit
authors.initials: G
authors.lastname: Hershkovits
authors.forename: Don J
authors.initials: DJ
authors.lastname: Katcoff
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D004926:Escherichia coli / Q000145:classification / Q000187:drug effects* / Q000235:genetics; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D005853:Geriatrics; D006760:Hospitalization; D006801:Humans; D032023:Integrons / Q000235:genetics*; D007557:Israel / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D010957:Plasmids; D012703:Serotyping; D018440:beta-Lactam Resistance / Q000235:genetics*; D001618:beta-Lactamases / Q000235:genetics* / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases