Community and hospital spread of Escherichia coli producing CTX-M extended-spectrum β-lactamases in the UK

Neil Woodford, M. E. Ward, M. E. Kaufmann, Jane Turton, E. J. Fagan, D. James, Alan Johnson, Rachel Pike, Marina Warner, Thomas Cheasty, A. Pearson, S. Harry, J. B. Leach, A. Loughrey, J. A. Lowes, R. E. Warren, D. M. Livemore

Research output: Contribution to journalArticlepeer-review

407 Citations (Scopus)

Abstract

Objectives: During 2003, the Health Protection Agency's Antibiotic Resistance Monitoring and Reference Laboratory began to receive isolates of Escherichia coli for confirmation of extended-spectrum β-lactamase production with a phenotype implying a CTX-M-type β-lactamase, i.e. MICs of cefotaxime ≥8-fold higher than MICs of ceftazidime. Many were referred as being from community patients. We examined 291 CTX-M-producing isolates from the UK and investigated the genetic basis of their phenotype. Methods: PCR was used to detect alleles encoding CTX-M enzymes and to assign these to their blaCTX-M phylogenetic groups. Selected alleles were sequenced. Producers were compared by analysis of banding patterns generated by pulsed-field gel electrophoresis of XbaI-digested genomic DNA. MICs were determined by an agar dilution method or by Etest. Results: Of 291 CTX-M-producing E. coli isolates studied from 42 UK centres, 70 (24%) were reportedly from community patients, many of whom had only limited recent hospital contact. Community isolates were referred by 12 centres. Two hundred and seventy-nine (95.9%) producers contained genes encoding group 1 CTX-M enzymes and 12 contained blaCTX-M-9-like alleles. An epidemic CTX-M-15-producing strain was identified, with 110 community and inpatient isolates referred from six centres. Representatives of four other major strains also produced CTX-M-15, as did several sporadic isolates examined. Most producers were multi-resistant to fluoroquinolones, trimethoprim, tetracycline and aminoglycosides as well as to non-carbapenem β -lactams. Conclusions: CTX-M-producing E. coli are a rapidly developing problem in the UK, with CTX-M-15 particularly common. The diversity of producers and geographical scatter of referring laboratories indicates wide dissemination of blaCTX-M genes. Because of the public health implications, including for the treatment of community-acquired urinary tract infections, the spread of these strains - and CTX-M-15 β-lactamase in particular - merits close monitoring.

Original languageEnglish
Pages (from-to)735-743
Number of pages9
JournalJournal of Antimicrobial Chemotherapy
Volume54
Issue number4
DOIs
Publication statusPublished - Oct 2004

Keywords

  • CTM-M β-lactamases
  • Community infections
  • ESBLs
  • Molecular epidemiology

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