title: Nationwide survey of extended-spectrum {beta}-lactamase-producing Enterobacteriaceae in the French community setting.
abstract: OBJECTIVE
  The aim of this study was to assess the prevalence of the extended-spectrum beta-lactamase (ESBL)-producing enterobacteria (ESBLE) in the French community, during a 2006 survey.
  
  
  METHODS
  All enterobacteria isolated from urine samples of patients, exhibiting a decreased susceptibility to broad-spectrum cephalosporins, were analysed for their beta-lactamase content (synergy test, isoelectrofocusing, conjugation transfer, PCR amplification and/or cloning experiments and sequencing). Additional co-resistances were investigated by PCR, sequencing and/or cloning. Epidemiological relationship was studied by PFGE for all species and, in addition, for Escherichia coli by the determination of the phylogenetic group, multilocus sequence type (ST) and O25b antigen. Characteristics of CTX-M-producing E. coli carriers were compared with other ESBLE carriers.
  
  
  RESULTS
  Seventy-two ESBLE were collected from 71 patients. Most of them expressed a CTX-M enzyme (n = 42, comprising 40 E. coli), with a predominance of CTX-M-15 (n = 24); 10 CTX-M-15-producing E. coli belonged to the same clone (phylogroup B2, ST131, serotype O25b). The 30 remaining strains possessed a TEM- or SHV-type ESBL. In addition, three strains presented unusual co-resistances such as DHA-1 (n = 2), QnrB4 and ArmA. Risk factors for ESBLE acquisition were substantially less frequent when the ESBL was of the CTX-M type, except for prior antimicrobial therapy. Eighteen percent of the patients were considered to have true community-acquired ESBLE; most of them harboured a CTX-M-producing E. coli.
  
  
  CONCLUSIONS
  This first nationwide study reports an ESBLE prevalence of 1.1% in the French community setting in 2006, mainly related to the presence of CTX-M-producing E. coli strains; furthermore, unusual co-resistances rarely found in the community setting were occasionally observed, which may threaten future emergence.
authors.affiliation: CNRS UMR, Université Bordeaux, France. corinne.arpin@bacterio.u-bordeaux2.fr
authors.forename: C
authors.initials: C
authors.lastname: Arpin
authors.forename: C
authors.initials: C
authors.lastname: Quentin
authors.forename: F
authors.initials: F
authors.lastname: Grobost
authors.forename: E
authors.initials: E
authors.lastname: Cambau
authors.forename: J
authors.initials: J
authors.lastname: Robert
authors.forename: V
authors.initials: V
authors.lastname: Dubois
authors.forename: L
authors.initials: L
authors.lastname: Coulange
authors.forename: C
authors.initials: C
authors.lastname: André