title: Wide geographic spread of diverse acquired AmpC beta-lactamases among Escherichia coli and Klebsiella spp. in the UK and Ireland.
abstract: OBJECTIVE
  To determine the distribution of acquired AmpC beta-lactamases in 173 isolates of Escherichia coli and Klebsiella spp. submitted to the UK's national reference laboratory for antibiotic resistance.
  
  
  METHODS
  MICs were determined and interpreted according to BSAC guidelines. Candidate isolates were those resistant to cefotaxime and/or ceftazidime, irrespective of addition of clavulanic acid. Genes encoding six phylogenetic groups of acquired AmpC enzymes were sought by PCR. Selected isolates were compared by pulsed-field gel electrophoresis (PFGE), and one bla(AmpC) amplicon was sequenced.
  
  
  RESULTS
  Genes encoding acquired AmpC enzymes were detected in 67 (49%) candidate E. coli and 21 (55%) Klebsiella spp. Sixty isolates produced CIT-type enzymes, 14 had ACC types, 11 had FOX types and 3 had DHA enzymes. The low-level cephalosporin resistance of the remaining isolates (n = 85; 49%) was inferred to result from reduced permeability or, in E. coli, from hyperexpression of chromosomal ampC. Twenty-four E. coli isolates from one hospital produced a CIT-type enzyme, with 20 of these additionally producing a group 1 CTX-M extended-spectrum beta-lactamase. PFGE indicated that these isolates belonged to UK epidemic strain A, which normally produces CTX-M-15, but no acquired AmpC. Sequencing a representative bla(AmpC) amplicon indicated that in one centre this strain had acquired a novel CMY-2 variant, designated CMY-23.
  
  
  CONCLUSIONS
  Diverse acquired AmpC enzymes occur in E. coli and Klebsiella spp. isolates in the UK and Ireland, with CIT types the most common. Producers are geographically scattered, but with some local outbreaks. Acquisition of a CMY-2-like enzyme by E. coli epidemic strain A suggests that these enzymes may be poised to become an important public health issue.
authors.affiliation: Centre for Infections, Health Protection Agency, London, NW9 5EQ, UK. neil.woodford@hpa.org.uk
authors.forename: Neil
authors.initials: N
authors.lastname: Woodford
authors.forename: Suganya
authors.initials: S
authors.lastname: Reddy
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Fagan
authors.forename: Robert L R
authors.initials: RL
authors.lastname: Hill
authors.forename: Katie L
authors.initials: KL
authors.lastname: Hopkins
authors.forename: Mary E
authors.initials: ME
authors.lastname: Kaufmann
authors.forename: James
authors.initials: J
authors.lastname: Kistler
authors.forename: Marie-France I
authors.initials: MF
authors.lastname: Palepou
authors.forename: Rachel
authors.initials: R
authors.lastname: Pike
authors.forename: M Elaina
authors.initials: ME
authors.lastname: Ward
authors.forename: John
authors.initials: J
authors.lastname: Cheesbrough
authors.forename: David M
authors.initials: DM
authors.lastname: Livermore
mesh_terms: D001426:Bacterial Proteins / Q000235:genetics*; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics; D007494:Ireland; D007709:Klebsiella / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics; D008826:Microbial Sensitivity Tests; D006113:United Kingdom; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D001426:Bacterial Proteins; C048795:AmpC beta-lactamases; D001618:beta-Lactamases