Korean J Clin Microbiol.  1999 Mar;2(1):28-39.

Prevalence of Extended-spectrum beta-lactamase-producing Enterobacteriaceae and Evaluation of Methods for Detection

• Kim BL
• Jeong SH
• Koo JY
• Lee K
• Chong Y
• Jeong TJ
• Hwang HY
• Kim MH

Abstract

BACKGROUND: Increased isolation of extended-spectrum beta-lactamase (ESBL)-producing Entero bacteriaceae resistant to third generation cephalosporins and aztreonam has been noted recently. This study was to determine the prevalence of resistance to these drugs and ESBL in Enterobacteriaceae and to evaluate the methods for de tection.
METHODS
During the period of October, 1997 and March, 1998, a total of 731 clinical isolates of Enterobacteriaceae were collected from patients of the Kosin Medical Center, Pusan, Korea. Antimicrobial susceptibility test by disk diffusion method and double disk synergy test were performed. MICs of beta-lactams were determined by agar dilution method. And ESBL genotypes were determined by polymerase chain reaction.
RESULTS
About 10% of Escherichia coli isolates and 20% of Klebsiella pneumoniae isolates were intermediate or resistant to the third generation cephalosporins or aztreonam. Sensitivities of cefotaxime, ceftazidime, ceftriaxone and cefpodoxime disks for the detection of ESBL- producing strains of E. coli and K. pneumoniae by NCCLS standards were 100%, respectively, but that of aztreonam disk was 97%. Positive predictive value of the ceftazidime disk was higher than those of other disks. Twenty strains of E. coli, 20 K pneumoniae, 19 Enterobacter spp., six Citrobacter freundii, and eight Serratia marcescens showed positive results in double disk synergy test. The transconjugant strain of K. pneumoniae K20482 had blaSHV, and remains of transconjugants of ESBL-producing K. pneumoniae, Enterobacter spp. and S. marcescens had blaTEM.
CONCLUSIONS
In this study, many strains of Enterobacteriaceae isolated in Korea were resistant to third generation cephalosporins and aztreonam. Some of the strains of Enterobacter spp. and S. marcescens as well as E. coli and K. pneumoniae produced ESBL, and majority of these strains had blaTEM. In the detection of ESBL-producing strains of E. coli and K. pneumoniae by NCCLS standards, all of the antimicrobial agent disks tested were useful, but ceftazidime disk was most effective because of its highest positive predictive value.

Keyword

Enterobacteriaceae; Extended-spectrum beta-lactamase; TEM; SHV; Third generation cephalosporins; Aztreonam

MeSH Terms

Agar
Aztreonam
beta-Lactamases
beta-Lactams
Busan
Cefotaxime
Ceftazidime
Ceftriaxone
Cephalosporins
Citrobacter freundii
Diffusion
Enterobacter
Enterobacteriaceae*
Escherichia coli
Genotype
Humans
Klebsiella pneumoniae
Korea
Pneumonia
Polymerase Chain Reaction
Prevalence*
Serratia marcescens
Agar
Aztreonam
Cefotaxime
Ceftazidime
Ceftriaxone
Cephalosporins
beta-Lactamases
beta-Lactams