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Journal of Clinical Microbiology, October 2005, p. 5048-5054, Vol. 43, No. 10
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.10.5048-5054.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Clinical and Molecular Analysis of Extended-Spectrum ß-Lactamase-Producing Enterobacteria in the Community Setting

Corinne Arpin,¹ Véronique Dubois,¹ Jeanne Maugein,² Jacqueline Jullin,³ Brigitte Dutilh,³ Jean-Philippe Brochet,³ Gilberte Larribet,³ Isabelle Fischer,³ and Claudine Quentin^1*

EA525, Laboratoire de Microbiologie, Faculté de Pharmacie, Université de Bordeaux 2, Bordeaux, France,¹ Laboratoire de Bactériologie, Hôpital Haut-Lévêque, Pessac, France,² Laboratoires d'Analyses Médicales du Réseau Aquitaine, Bordeaux, France³

Received 8 February 2005/ Returned for modification 30 March 2005/ Accepted 8 July 2005

During a previous survey, five extended-spectrum ß-lactamase (ESBL)-producing enterobacteria (ESBLE) (two Enterobacter aerogenes isolates expressing TEM-24b, two Escherichia coli isolates expressing TEM-21 or TEM-24b, and one Klebsiella pneumoniae isolate expressing SHV-4/TEM-15) responsible for urinary tract infections (UTIs) were found among 1,584 strains collected from community patients. The aim of the present study was to elucidate the route of emergence of these typically nosocomial organisms in the community. Thus, the files of the five patients were analyzed over at least a decade, and potentially related ESBLE from hospitals or clinics were examined. Their enzymes were characterized at a molecular level, and the strains were typed by amplified-primed PCR, enterobacterial repetitive intergenic consensus PCR, and restriction plasmid profile. All patients (C1 to C5) had risk factors for ESBLE acquisition, including past history of hospitalization (2.5 to 23 months before). Four (C1 and C3 to C5) had previously received antibiotics (concomitantly to 35 months earlier), two (C1 and C3) had indwelling urinary catheters and recurrent UTIs, and three (C2, C3, and C5) formerly experienced ESBLE-induced UTIs (2 to 11 months before). The same ESBLE and/or an identical or similar ESBL-encoding plasmid was identified in the hospital ward (C1 to C4) or in a clinic (C5) where the patients had previously resided. Patients C1 and C4, infected with different ESBLE carrying a closely related plasmid, were hospitalized in the same unit. Persistence of ESBLE over at least a 5-year period was demonstrated for patient C3. Thus, community-acquired UTIs in these patients likely resulted from nosocomially acquired ESBLE or an ESBL-encoding plasmid followed by a prolonged digestive carriage.

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* Corresponding author. Mailing address: Laboratoire de Microbiologie, Faculté de Pharmacie, Université de Bordeaux 2, 146 rue Léo Saignat, 33076 Bordeaux Cedex, France. Phone: 33-5-57571075. Fax: 33-5-56909072. E-mail: claudine.quentin{at}bacterio.u-bordeaux2.fr.

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Journal of Clinical Microbiology, October 2005, p. 5048-5054, Vol. 43, No. 10
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.10.5048-5054.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

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