Ann Clin Microbiol.  2019 Mar;22(1):1-8. 10.5145/ACM.2019.22.1.1.

Differences in Antimicrobial Resistance Phenotypes by the Group of CTX-M Extended-Spectrum β-Lactamase

• Gwon B
• Yoon EJ
• Kim D
• Lee H
• Shin JH
• Shin JH
• Shin KS
• Kim YA
• Uh Y
• Kim HS
• Kim YR
• Jeong SH

• KMID: 2441650
• DOI: http://doi.org/10.5145/ACM.2019.22.1.1

Abstract

BACKGROUND
Escherichia coli and Klebsiella pneumoniae clinical isolates producing CTX-M extendedspectrum β-lactamases (ESBLs) were assessed for antimicrobial resistance phenotypes varied by group of enzymes.
METHODS
A total of 1,338 blood isolates, including 959 E. coli and 379 K. pneumoniae, were studied. All the strains were collected between January and July 2017 from eight general hospitals in South Korea. The species were identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Antimicrobial susceptibilities were determined by disk diffusion methods and ESBL phenotypes by double-disk synergy tests using disks containing cefotaxime, ceftazidime, cefepime, aztreonam, and clavulanic acid (CA). The genes for β-lactamases were identified by PCR and sequencing.
RESULTS
Of total microbes, 31.6% (303/959) E. coli and 24.0% (91/379) K. pneumoniae were resistant to cefotaxime and 28.1% (269/959) E. coli and 20.1% (76/379) K. pneumoniae were CTX-M-type ESBL producers. Among the detected CTX-M ESBLs, 58.0% (156/269) in E. coli and 86.8% (66/76) in K. pneumoniae belonged to group 1, 46.8% (126/269) in E. coli and 14.5% (11/76) in K. pneumoniae were group 9. Ten E. coli and one K. pneumoniae isolates co-produced both groups of CTX-M ESBL. The group 1 CTX-M producers had a higher level of resistance to cefotaxime, ceftazidime, cefepime, and aztreonam and exhibited stronger synergistic activities when combined with CA compared to group 9.
CONCLUSION
ESBL phenotypes differ by CTX-M ESBL group and phenotype testing with drugs including 4th generation cephalosporins and monobactams is critical for screening CTX-M-producers with better sensitivity.

Keyword

CTX-M; Escherichia coli; Extended-spectrum β-lactamase; Klebsiella pneumoniae

MeSH Terms

Aztreonam
Cefotaxime
Ceftazidime
Cephalosporins
Clavulanic Acid
Diffusion
Escherichia coli
Hospitals, General
Klebsiella pneumoniae
Korea
Mass Screening
Mass Spectrometry
Monobactams
Phenotype*
Pneumonia
Polymerase Chain Reaction
Aztreonam
Cefotaxime
Ceftazidime
Cephalosporins
Clavulanic Acid
Monobactams

Figure

• 

  Fig. 1 Zone diameter of the four drugs (A and C) and the synergy with clavulanic acid (SC) (B and D) by bacterial species (A and B) and by groups of CTX-M (C and D). A total of 269 E. coli (ECO) and 76 K. pneumoniae (KPN) CTX-M producers (A and B) including 211 group 1 CTX-M producers and 123 group 9 CTX-M producers (C and D) were plotted. Boxplots present the 1 and 3 quartiles with whiskers showing either the maximum and minimum values. The thick horizontal line indicates median values, black lines for E. coli or group 1 CTX-M and gray lines for K. pneumoniae or group 9 CTX-M ESBL producers. The SC value was calculated by dividing the enlarged zone diameter near the CA disk by inhibition zone diameter of each drug. The statistical significance was calculated using Pearson's chi-square test [16] by using SPSS statistics (version 23, IBM Corp., Armonk, NY, USA) and the significance (P) was indicated by using asterisks: **P<0.01; *P<0.05.

• 

  Fig. 2 Correlation between synergy with clavulanic acid (SC) of cefotaxime and ceftazidime SC (A), cefepime SC (B), and aztreonam SC (C). The SC was calculated by dividing the enlarged zone diameter near the clavulanic acid disk by inhibition zone diameter of each drug. The correlation coefficient (r) was calculated using Pearson's correlation [16] by the parametric method using SPSS statistics and the significance (P) was determined by a two-tailed method using the correlation value and the sample size. Each dot indicates one strain, gray triangles and black dots indicate strains producing CTX-M group 1 and group 9, respectively.

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