title: Faecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae among humans in Java, Indonesia, in 2001-2002.
abstract: OBJECTIVE
  To characterise commensal Escherichia coli and other Enterobacteriaceae with reduced susceptibility to cefotaxime that were collected in a large survey carried out among 3995 patients and healthy persons in two urban regions on Java, Indonesia, in 2001-2002.
  
  
  METHODS
  The putative extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae were analysed using double-disk synergy tests, isoelectric focusing, PCR assays, DNA sequencing, and pulsed-field gel electrophoresis (PFGE).
  
  
  RESULTS
  On the day of discharge after five or more days of hospitalisation, at least 95 of 999 (9.5%) patients carried ESBL-positive Enterobacteriaceae as dominant faecal flora. Six patients were simultaneously colonised with E. coli and Klebsiella pneumoniae isolates with ESBL activity. On admission, only 6 of 998 (0.6%) patients were colonised. Faecal carriage of ESBL-producing Enterobacteriaceae among healthy persons or persons visiting a public health centre was not detected. The 107 ESBL-positive strains included 68 E. coli, 35 K. pneumoniae, and four other Enterobacteriaceae. bla(CTX-M-15) was the most prevalent ESBL in both E. coli (47.1%) and K. pneumoniae (45.7%), but the E. coli O25b-ST131 clone was virtually absent. Other ESBL types found were: SHV-2, -2a, -5, -12, CTX-M-3, -9, -14, and TEM-19. PFGE revealed extensive genetic diversity among the isolates.
  
  
  CONCLUSIONS
  In 2001-2002, faecal carriage of ESBL-producing Enterobacteriaceae as dominant flora in Indonesia was almost exclusively hospital-associated. The presence of various bla(ESBL) genes and the extensive genetic diversity among isolates argue against a single/dominant strain outbreak.
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands. j.severin@erasmusmc.nl
authors.forename: Juliëtte A
authors.initials: JA
authors.lastname: Severin
authors.forename: Endang Sri
authors.initials: ES
authors.lastname: Lestari
authors.forename: Wendy
authors.initials: W
authors.lastname: Kloezen
authors.forename: Nicole
authors.initials: N
authors.lastname: Lemmens-den Toom
authors.forename: Ni Made
authors.initials: NM
authors.lastname: Mertaniasih
authors.forename: Kuntaman
authors.initials: K
authors.lastname: Kuntaman
authors.forename: Marijam
authors.initials: M
authors.lastname: Purwanta
authors.forename: D Offra
authors.initials: DO
authors.lastname: Duerink
authors.forename: Usman
authors.initials: U
authors.lastname: Hadi
authors.forename: Alex
authors.initials: A
authors.lastname: van Belkum
authors.forename: Henri A
authors.initials: HA
authors.lastname: Verbrugh
authors.forename: Wil H
authors.initials: WH
authors.lastname: Goessens
mesh_terms: D000328:Adult; D016000:Cluster Analysis; D016521:Electrophoresis, Gel, Pulsed-Field; D004926:Escherichia coli / Q000235:genetics / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007297:Inpatients / Q000706:statistics & numerical data*; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000235:genetics / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D017422:Sequence Analysis, DNA; D055815:Young Adult; D001618:beta-Lactamases / Q000235:genetics / Q000302:isolation & purification*
chemical_list: D001618:beta-Lactamases