title: [Characterization of ESBL-producing Escherichia coli and Klebsiella pneumoniae strains isolated from urine of nonhospitalized patients in the Zagreb region].
abstract: OBJECTIVE
  To determine the prevalence of ESBL-producing Escherichia coli and Klebsiella pneumoniae strains isolated from urine of nonhospitalized patients during a three-year period, to determine their antibiotic susceptibility, investigate the transfer of ESBL genes with cotransfer of resistance and to characterize isolated beta-lactamases.
  
  
  METHODS
  Antimicrobial susceptibility was determined by disk diffusion and broth microdilution methods. The double-disk test was used for ESBL detection. Transfer of resistance was performed by broth mating method and characterization of isolated beta-lactamases by polymerase chain reaction.
  
  
  RESULTS
  The prevalence of ESBL-producing E. coli was 1.5% and of K. pneumoniae 4.1% with its different distribution according to patients' age and gender. ESBL-producing K. pneumoniae showed high resistance rates to aminoglycosides, cotrimoxazole, nitrofurantoin and quinolones while ESBL-producing E. coli isolates, with exception of high aminoglycoside resistance, showed low resistance rates to other antibiotics. Successful conjugation of ESBL genes was obtained with 25% E. coli and 76.2% K. pneumoniae strains. Comparing to E. coli, K. pneumoniae strains showed higher rates of aminoglycoside and cotrimoxazole resistance cotransfer. Beta-lactamases of investigated strains belonged to TEM, SHV and CTX-M families.
  
  
  CONCLUSIONS
  The existence of multiple-resistant ESBL-producing E. coli and K. pneumoniae strains was confirmed in observed outpatient population. ESBL-producing K. pneumoniae isolates, in contrast to ESBL-producing E. coli, showed higher resistance rates to non-beta-lactam antibiotics, probably caused by cotransfer of resistance genes located on the same plasmid as ESBL genes. It is important to monitor the prevalence of such strains and their possible spreading in the outpatient population of the Zagreb region.
authors.affiliation: Zavod za javno zdravstvo "Dr. Andrija Stampar", Zagreb, Hrvatska. tatjana.marijan@stampar.hr
authors.forename: Tatjana
authors.initials: T
authors.lastname: Marijan
authors.forename: Vanda
authors.initials: V
authors.lastname: Plecko
authors.forename: Jasmina
authors.initials: J
authors.lastname: Vranes
authors.forename: Ana Mlinarić
authors.initials: AM
authors.lastname: Dzepina
authors.forename: Branka
authors.initials: B
authors.lastname: Bedenić
authors.forename: Smilja
authors.initials: S
authors.lastname: Kalenić
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000187:drug effects / Q000201:enzymology* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000382:microbiology*; D005260:Female; D006801:Humans; D007223:Infant; D007710:Klebsiella Infections / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D014552:Urinary Tract Infections / Q000382:microbiology*; D014556:Urine / Q000382:microbiology*; D055815:Young Adult; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D001618:beta-Lactamases