title: Occurrence and molecular analysis of extended-spectrum {beta}-lactamase-producing Proteus mirabilis in Hong Kong, 1999-2002.
abstract: OBJECTIVE
  A study was conducted to evaluate the occurrence and characterization of extended-spectrum beta-lactamases (ESBLs) among blood isolates of Proteus mirabilis collected over a 4 year period in Hong Kong.
  
  
  METHODS
  Production of ESBLs among 99 consecutive and non-duplicate isolates was evaluated by the double-disc synergy test. The ESBLs were characterized by isoelectric focusing and PCR sequencing using specific primers. The epidemiological relationship of the isolates was studied by the Dienes test and PFGE.
  
  
  RESULTS
  ESBLs were identified in 13 isolates, from none in 1999-2000 and up to 18.5% (5/27) in 2001 and 25.8% (8/31) in 2002. The ESBL-producing isolates were more resistant to ceftriaxone than to ceftazidime, and were more likely than non-ESBL-producers to have resistance to ciprofloxacin (76.9% versus 14%) and gentamicin (38.5% versus 9.3%). The ESBL content included CTX-M-13 (n=8), CTX-M-14 (n=3), SHV-5 (n=2), TEM-11 (n=1), and an unidentified ESBL with a pI of 7.5. The Dienes test revealed that the genetic background in the 99 isolates was highly heterogeneous, with 54 distinct types among 92 isolates and seven were non-typeable. Among the 13 ESBL-producing isolates, five different backgrounds, including one cluster (Dienes-pulsotype A) with nine isolates, were identified by both Dienes test and PFGE, thus suggesting both clonal and multi-clonal spread of the CTX-M enzymes.
  
  
  CONCLUSIONS
  Our findings indicate the emergence of CTX-M enzymes among P. mirabilis in Hong Kong. More ESBL screening of this species is required to improve their recognition.
authors.affiliation: Division of Infectious Diseases, Department of Microbiology and Centre of Infection, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China. plho@hkucc.hku.hk
authors.forename: P L
authors.initials: PL
authors.lastname: Ho
authors.forename: Alex Y M
authors.initials: AY
authors.lastname: Ho
authors.forename: K H
authors.initials: KH
authors.lastname: Chow
authors.forename: River C W
authors.initials: RC
authors.lastname: Wong
authors.forename: R S
authors.initials: RS
authors.lastname: Duan
authors.forename: W L
authors.initials: WL
authors.lastname: Ho
authors.forename: Gannon C
authors.initials: GC
authors.lastname: Mak
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Tsang
authors.forename: W C
authors.initials: WC
authors.lastname: Yam
authors.forename: K Y
authors.initials: KY
authors.lastname: Yuen
mesh_terms: D024881:Drug Resistance, Bacterial / Q000235:genetics; D006801:Humans; D008826:Microbial Sensitivity Tests; D010957:Plasmids; D011513:Proteus mirabilis / Q000145:classification / Q000187:drug effects / Q000201:enzymology*; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000235:genetics
chemical_list: D001618:beta-Lactamases