title: Clinical and molecular analysis of extended-spectrum {beta}-lactamase-producing enterobacteria in the community setting.
abstract: During a previous survey, five extended-spectrum beta-lactamase (ESBL)-producing enterobacteria (ESBLE) (two Enterobacter aerogenes isolates expressing TEM-24 b, two Escherichia coli isolates expressing TEM-21 or TEM-24 b, and one Klebsiella pneumoniae isolate expressing SHV-4/TEM-15) responsible for urinary tract infections (UTIs) were found among 1,584 strains collected from community patients. The aim of the present study was to elucidate the route of emergence of these typically nosocomial organisms in the community. Thus, the files of the five patients were analyzed over at least a decade, and potentially related ESBLE from hospitals or clinics were examined. Their enzymes were characterized at a molecular level, and the strains were typed by amplified-primed PCR, enterobacterial repetitive intergenic consensus PCR, and restriction plasmid profile. All patients (C1 to C5) had risk factors for ESBLE acquisition, including past history of hospitalization (2.5 to 23 months before). Four (C1 and C3 to C5) had previously received antibiotics (concomitantly to 35 months earlier), two (C1 and C3) had indwelling urinary catheters and recurrent UTIs, and three (C2, C3, and C5) formerly experienced ESBLE-induced UTIs (2 to 11 months before). The same ESBLE and/or an identical or similar ESBL-encoding plasmid was identified in the hospital ward (C1 to C4) or in a clinic (C5) where the patients had previously resided. Patients C1 and C4, infected with different ESBLE carrying a closely related plasmid, were hospitalized in the same unit. Persistence of ESBLE over at least a 5-year period was demonstrated for patient C3. Thus, community-acquired UTIs in these patients likely resulted from nosocomially acquired ESBLE or an ESBL-encoding plasmid followed by a prolonged digestive carriage.
authors.affiliation: EA525, Laboratoire de Microbiologie, Faculté de Pharmacie, Université de Bordeaux 2, Bordeaux, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Arpin
authors.forename: Véronique
authors.initials: V
authors.lastname: Dubois
authors.forename: Jeanne
authors.initials: J
authors.lastname: Maugein
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Jullin
authors.forename: Brigitte
authors.initials: B
authors.lastname: Dutilh
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Brochet
authors.forename: Gilberte
authors.initials: G
authors.lastname: Larribet
authors.forename: Isabelle
authors.initials: I
authors.lastname: Fischer
authors.forename: Claudine
authors.initials: C
authors.lastname: Quentin
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D004755:Enterobacteriaceae / Q000145:classification* / Q000187:drug effects / Q000201:enzymology / Q000235:genetics; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010957:Plasmids; D016133:Polymerase Chain Reaction; D015183:Restriction Mapping; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000382:microbiology; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000235:genetics; D047090:beta-Lactams / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D001618:beta-Lactamases