title: Emergence in Spain of a multidrug-resistant Enterobacter cloacae clinical isolate producing SFO-1 extended-spectrum beta-lactamase.
abstract: Between February 2006 and October 2009, 38 patients in different wards at the A Coruña University Hospital (northwest Spain) were either infected with or colonized by an epidemic, multidrug-resistant (MDR), and extended-spectrum-β-lactamase (ESBL)-producing strain of Enterobacter cloacae (EbSF), which was susceptible only to carbapenems. Semiautomated repetitive extragenic palindromic sequence-based PCR (rep-PCR) and pulsed-field gel electrophoresis (PFGE) analysis revealed that all of the E. cloacae isolates belonged to the same clone. Cloning and sequencing enabled the detection of the SFO-1 ESBL in the epidemic strain and the description of its genetic environment. The presence of the ampR gene was detected upstream of bla(SFO-1), and two complete sequences of IS26 surrounding ampR and ampA were detected. These IS26 sequences are bordered by complete left and right inverted repeats (IRL and IRR, respectively), which suggested that they were functional. The whole segment flanked by two IS26 copies may be considered a putative large composite transposon. A gene coding for aminoglycoside acetyltransferase (gentamicin resistance gene [aac3]) was found downstream of the 3' IS26. Despite the implementation of strict infection control measures, strain EbSF spread through different areas of the hospital. A case-control study was performed to assess risk factors for EbSF acquisition. A multivariate analysis revealed that the prior administration of β-lactam antibiotics, chronic renal failure, tracheostomy, and prior hospitalization were statistically associated with SFO-1-producing E. cloacae acquisition. This study describes for the first time an outbreak in which an SFO-1-producing E. cloacae strain was involved. Note that so far, this β-lactamase has previously been isolated in only a single case of E. cloacae infection in Japan.
authors.affiliation: Servicio de Microbiología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Fernández
authors.forename: María José
authors.initials: MJ
authors.lastname: Pereira
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Suárez
authors.forename: Margarita
authors.initials: M
authors.lastname: Poza
authors.forename: Mercedes
authors.initials: M
authors.lastname: Treviño
authors.forename: Pilar
authors.initials: P
authors.lastname: Villalón
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Sáez-Nieto
authors.forename: Benito José
authors.initials: BJ
authors.lastname: Regueiro
authors.forename: Rosa
authors.initials: R
authors.lastname: Villanueva
authors.forename: Germán
authors.initials: G
authors.lastname: Bou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015373:Bacterial Typing Techniques; D003001:Cloning, Molecular; D004251:DNA Transposable Elements; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D016972:Enterobacter cloacae / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D016133:Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D013030:Spain / Q000453:epidemiology; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D004251:DNA Transposable Elements; D001618:beta-Lactamases