Regional Spread of CTX-M-2-Producing Proteus mirabilis with the Identical Genetic Structure in Japan.
OBJECTIVE
In this study, we analyzed the molecular epidemiology of extended-spectrum β-lactamase (ESBL)-producing Proteus mirabilis isolates collected from the central region of Japan.


METHODS
Between 2005 and 2012, 820 clinical P. mirabilis isolates were obtained from ten acute care hospitals in Japan. We characterized ESBL confirmatory test-positive isolates by sequencing the ESBL genes and their flanking regions, detecting plasmid replicons, and performing pulsed-field gel electrophoresis (PFGE).


RESULTS
Ninety-six isolates (12%) were positive according to the ESBL confirmatory test; all these isolates possessed blaCTX-M-2with the same flanking structure of upstream ΔISEcp1 and a downstream region identical to downstream blaKLUA-1. IncT was the prevalent, and only, replicon found in 63 isolates. PFGE analysis detected eight clusters with more than one isolate, among which three included 56 isolates and six included isolates from multiple hospitals.


CONCLUSIONS
CTX-M-2-producing P. mirabilis with an identical genetic structure flanking blaCTX-M-2is dominant in this Japanese region, and there is evidence for the clonal spread of isolates.
1 Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine , Kyoto, Japan .|2 Department of Anesthesia, Kyoto University Graduate School of Medicine , Kyoto, Japan .
Karin
K
Kato
1 Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine , Kyoto, Japan .
Yasufumi
Y
Matsumura
1 Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine , Kyoto, Japan .
Masaki
M
Yamamoto
1 Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine , Kyoto, Japan .
Miki
M
Nagao
1 Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine , Kyoto, Japan .
Shunji
S
Takakura
1 Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine , Kyoto, Japan .
Satoshi
S
Ichiyama
D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016521:Electrophoresis, Gel, Pulsed-Field; D015870:Gene Expression; D006761:Hospitals; D006801:Humans; D007527:Isoenzymes / Q000235:genetics / Q000378:metabolism; D007564:Japan / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D010957:Plasmids / Q000737:chemistry / Q000378:metabolism*; D011512:Proteus Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission*; D011513:Proteus mirabilis / Q000145:classification / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D012093:Replicon; D017422:Sequence Analysis, DNA; D001618:beta-Lactamases / Q000235:genetics* / Q000378:metabolism
D000900:Anti-Bacterial Agents; D007527:Isoenzymes; C071167:beta-lactamase CTX-2; D001618:beta-Lactamases
CTX-M-2; ESBLs; IncT; Proteus mirabilis; clonal spread