Prevalence and molecular epidemiology of acquired AmpC β-lactamases and carbapenemases in Enterobacteriaceae isolates from 35 hospitals in Spain

• Published in: European journal of clinical microbiology & infectious diseases 2013-02, Vol.32 (2), p.253-259
• Main Authors: Miró, E., Agüero, J., Larrosa, M. N., Fernández, A., Conejo, M. C., Bou, G., González-López, J. J., Lara, N., Martínez-Martínez, L., Oliver, A., Aracil, B., Oteo, J., Pascual, A., Rodríguez-Baño, J., Zamorano, L., Navarro, F.
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - pharmacology; beta -Lactamase; beta-Lactamases - genetics; beta-Lactamases - secretion; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; carbapenemase; Carbapenems; Cephalosporins; Cross Infection - epidemiology; Cross Infection - microbiology; DNA, Bacterial - chemistry; DNA, Bacterial - genetics; Electrophoresis, Gel, Pulsed-Field; Enterobacteriaceae; Enterobacteriaceae - classification; Enterobacteriaceae - enzymology; Enterobacteriaceae - genetics; Enterobacteriaceae - isolation & purification; Enterobacteriaceae Infections - epidemiology; Enterobacteriaceae Infections - microbiology; Enzymes; Epidemiology; Escherichia coli; Gel electrophoresis; Genetic diversity; Genotype; Hospitals; Humans; Imipenem; Infectious diseases; Inosine monophosphate; Internal Medicine; Klebsiella; Medical Microbiology; Medical sciences; Microbial Sensitivity Tests; Minimum inhibitory concentration; Molecular Epidemiology; Plasmids - analysis; Polymerase Chain Reaction; Prevalence; Prospective Studies; Proteus mirabilis; Sequence Analysis, DNA; Spain - epidemiology
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-012-1737-0

The purpose of this investigation was to determine the prevalence of plasmid-mediated AmpC (pAmpC) and carbapenemases in Enterobacteriaceae collected from 35 hospitals in Spain and to establish their epidemiological relationships. We conducted a prospective multi-centre study on pAmpC- or carbapenemase-producing Enterobacteriaceae isolates from clinical samples collected from February to July 2009. The strains suspected to carry pAmpC were resistant or showed intermediate susceptibility to co-amoxiclav and second- or third-generation cephalosporins. Strains suspected to carry a carbapenemase were selected because they showed a minimum inhibitory concentration (MIC) to imipenem >1 mg/L. Polymerase chain reaction (PCR) and a sequencing strategy were used to characterise the enzymes. The clonal relationships between isolates was analysed by pulsed field gel electrophoresis (PFGE). Among 100,132 Enterobacteriaceae isolates collected, 1,654 were compatible with the production of pAmpC or carbapenemases. We found a prevalence of 0.64 % of pAmpC ( n  = 635) and 0.04 % of carbapenemases ( n  = 43). The most prevalent pAmpC enzymes were CMY-type (78.3 %), DHA-type (19.5 %), ACC-type (1.6 %) and FOX-type (0.6 %). The CMY-type was the most frequent in Escherichia coli and Proteus mirabilis species, whereas the DHA-type was mainly found in Klebsiella spp. The enzymes involved in carbapenem resistance were VIM-1, IMP-22 and the new IMP-28. Nine new bla genes were described: bla CMY-54 , bla CMY-55 , bla CMY-56 , bla CMY-57 , bla CMY-96 , bla DHA-6 , bla DHA-7 , bla FOX-8 and bla IMP-28 . The prevalence of pAmpC or carbapenemases found is not negligible. The CMY-types were the predominant pAmpC, whereas the VIM or IMP enzymes were the predominant carbapenemases. Furthermore, we observed a great genetic diversity among pAmpC-producing strains and a close clonal relationship between carbapenemase-producing strains.