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Journal of Clinical Microbiology, May 2006, p. 1659-1664, Vol. 44, No. 5
0095-1137/06/$08.00+0     doi:10.1128/JCM.44.5.1659-1664.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Trends in Production of Extended-Spectrum ß-Lactamases among Enterobacteria of Medical Interest: Report of the Second Italian Nationwide Survey

Francesco Luzzaro,1 Marilina Mezzatesta,2 Claudia Mugnaioli,3 Mariagrazia Perilli,4 Stefania Stefani,2 Gianfranco Amicosante,4 Gian Maria Rossolini,3 and Antonio Toniolo1*

Laboratory of Microbiology, Ospedale di Circolo and University of Insubria, Varese,1 Department of Microbiological Sciences, University of Catania, Catania,2 Department of Molecular Biology, University of Siena, Siena,3 Department of Sciences and Biomedical Technologies, University of L'Aquila, L'Aquila, Italy4

Received 22 November 2005/ Returned for modification 3 January 2006/ Accepted 6 March 2006

Results of a 2003 survey carried out in Italy to evaluate the prevalence of extended-spectrum ß-lactamase (ESBL)-producing enterobacteria are presented. Eleven Italian Microbiology Laboratories investigated 9,076 consecutive nonreplicate isolates (inpatients, 6,850; outpatients, 2,226). ESBL screening was performed by MIC data analysis. Confirmation was obtained using the double-disk synergy test and the combination disk test based on CLSI methodology. ESBL determinants were investigated by colony blot hybridization and confirmed by sequencing. Results were compared to those of the 1999 Italian survey (8,015 isolates). The prevalence of ESBL producers was 7.4% among isolates from inpatients (in 1999, 6.3%) and 3.5% among outpatients (no data were available for 1999). Among hospitalized patients, the most prevalent ESBL-positive species was Escherichia coli (Klebsiella pneumoniae in 1999). Proteus mirabilis was the most prevalent ESBL-positive species among outpatients. In both groups, most ESBL-positive pathogens were obtained from urinary tract infections. TEM-type ESBLs were the most prevalent enzymes (45.4%). Non-TEM, non-SHV determinants emerged: CTX-M-type in E. coli and K. pneumoniae, and PER-type in P. mirabilis, Providencia spp., and E. coli. With the exception of 3/163 P. mirabilis isolates and 1/44 Providencia stuartii isolate (all of which were intermediate for imipenem), carbapenems were active against all ESBL-positive enterobacteria. Susceptibility to other drugs was as follows: 84.7% for amikacin, 84.4% for piperacillin-tazobactam, 48.0% for gentamicin, and 32.8% for ciprofloxacin. Carbapenems appear to be the drug of choice. Amikacin and ß-lactam/ß-lactamase inhibitor combinations represent an alternative in non-life-threatening infections. The appearance of ESBL-positive enterobacteria in the community makes it mandatory that family physicians learn how to treat these pathogens.

* Corresponding author. Mailing address: Laboratory of Medical Microbiology, Università dell'Insubria and Ospedale di Circolo e Fondazione Macchi, Viale Borri, 57-21100 Varese, Italy. Phone: 39 0332 278309. Fax: 39 0332 260517. E-mail: antonio.toniolo{at}ospedale.varese.it.

Journal of Clinical Microbiology, May 2006, p. 1659-1664, Vol. 44, No. 5
0095-1137/06/$08.00+0     doi:10.1128/JCM.44.5.1659-1664.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



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