title: Molecular detection and epidemiology of extended-spectrum beta-lactamase genes prevalent in clinical isolates of Klebsiella pneumoniae and E coli from Trinidad and Tobago.
abstract: OBJECTIVE
  The epidemiology of Extended-spectrum beta-lactamase (ESBL) producing E coli and K pneumoniae is complex and varies among hospitals and countries. This study aimed at describing the molecular detection and epidemiology of ESBL subtypes prevalent in clinical isolates of K pneumonia and E coli in Trinidad and Tobago.
  
  
  METHODS
  Over 36-months, isolates of E coli and K pneumoniae from clinical specimens of patients processed at a regional tertiary hospital in the country,were identified using standard microbiological methods. MicroScan System (Siemens, USA) was used to determine MIC values while E-test (AB Biodisk, Sweden) assays phenotypically confirmed ESBL production. K pneumoniae (n = 65) and E coli (n = 25) isolates confirmed as ESBL producers were further subjected to multiplex PCR and PFGE tests to determine the ESBL subtypes and clonal relatedness.
  
  
  RESULTS
  Female patients (67.8%) and urine samples (65%) yielded most ESBL isolates, with over 90% recovered from the hospital's medicine and surgery facilities. All ESBL isolates including all K pneumoniae producing ESBLs were 100% susceptible to carbapenems and amikacin antimicrobials. Polymerase Chain Reaction detected 100% blaTEM genes, 4.1% blasHv and 37.5% blaCTX_M genes among E coli isolates. Similarly, 84.3% blaTEM, 34.5% blaSHV and 58.8% blaCTX-M genes were detected in K pneumoniae. Pulsed-field gel electrophoresis (PFGE) results showed diverse and unrelated clones.
  
  
  CONCLUSIONS
  In this the first report of molecular characterization and epidemiology ofESBL subtypes in E coli and K pneumoniae isolates in Trinidad and Tobago, the CTX-M, mainly phylogenetically group 1 type, was most predominant. Most ESBL isolates were still susceptible to carbapenems and aminoglycosides and their spread appears to be polyclonal and clonally unrelated.
authors.affiliation: Department of Para-Clinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad, West Indies. peakpaka@yahoo.co.uk
authors.forename: P E
authors.initials: PE
authors.lastname: Akpaka
authors.forename: B
authors.initials: B
authors.lastname: Legall
authors.forename: J
authors.initials: J
authors.lastname: Padman
mesh_terms: D000617:Aminoglycosides / Q000494:pharmacology; D015780:Carbapenems / Q000494:pharmacology; D016521:Electrophoresis, Gel, Pulsed-Field; D004926:Escherichia coli / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000235:genetics* / Q000382:microbiology; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000235:genetics* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics* / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D010641:Phenotype; D016133:Polymerase Chain Reaction; D014300:Trinidad and Tobago / Q000453:epidemiology; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D000617:Aminoglycosides; D015780:Carbapenems; C055184:beta-lactamase TEM-3; D001618:beta-Lactamases