Faecal carriage of extended‐spectrum β‐lactamase‐producing Enterobacteriaceae among humans in Java, Indonesia, in 2001–2002

• Published in: Tropical medicine & international health 2012-04, Vol.17 (4), p.455-461
• Main Authors: Severin, Juliëtte A., Lestari, Endang Sri, Kloezen, Wendy, Lemmens‐den Toom, Nicole, Mertaniasih, Ni Made, Kuntaman, Kuntaman, Purwanta, Marijam, Offra Duerink, D., Hadi, Usman, van Belkum, Alex, Verbrugh, Henri A., Goessens, Wil H.
• Format: Article
• Language: English
• Subjects: Adult; Antibacterial agents; antibiotic resistance; Antibiotics. Antiinfectious agents. Antiparasitic agents; Asia; Asie; beta-Lactamases - genetics; beta-Lactamases - isolation & purification; Biological and medical sciences; BLEE; BLSE; Cluster Analysis; colonisation; colonización; CTX‐M‐15; Electrophoresis, Gel, Pulsed-Field; Enterobacteriaceae; ESBL; Escherichia coli; Escherichia coli - genetics; Escherichia coli - isolation & purification; Escherichia coli Infections - epidemiology; Escherichia coli Infections - microbiology; Feces - microbiology; Female; General aspects; Humans; Indonesia - epidemiology; Inpatients - statistics & numerical data; Klebsiella Infections - epidemiology; Klebsiella Infections - microbiology; Klebsiella pneumoniae; Klebsiella pneumoniae - genetics; Klebsiella pneumoniae - isolation & purification; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; resistencia a antibióticos; Retrospective Studies; Risk Factors; résistance aux antibiotiques; Sequence Analysis, DNA; Young Adult
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/j.1365-3156.2011.02949.x

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. blaCTX‐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 blaESBL genes and the extensive genetic diversity among isolates argue against a single/dominant strain outbreak. Objectif:  Caractériser Escherichia coli et autres entérobactéries commensales présentant une sensibilité réduite au céfotaxime, recueillies dans le cadre d’une enquête étendue réalisée auprès de 3995 patients et personnes saines dans deux régions urbaines de Java, en Indonésie, en 2001–2002. Méthodes:  Les entérobactéries supposées productrices de β‐lactamase à spectre étendu (BLSE) ont été analysées en utilisant des tests synergiques à double‐disque, la focalisation isoélectrique, la PCR, le séquençage de l’ADN et l’électrophorèse en champ pulsé (PFGE). Résultats:  Le jour de leur sortie après cinq jours ou plus d’hospitalisation, au moins 95 des 999 (9,5%) patients testés portaient des entérobactéries BLSE comme flore fécale dominante. Six patients étaient simultanément colonisés par des isolats E. coli et Klebsiel