Inducible amp C beta-lactamase producing gram-negative bacilli from blood stream infections: frequency, antimicrobial susceptibility, and molecular epidemiology in a national surveillance program (SCOPE)

Michael A Pfaller; Ronald N Jones; Steven A Marshall; Stacy L Coffman; Richard J Hollis; Michael B Edmund; Richard P Wenzel

doi:10.1016/S0732-8893(97)00064-3

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Inducible amp C beta-lactamase producing gram-negative bacilli from blood stream infections: frequency, antimicrobial susceptibility, and molecular epidemiology in a national surveillance program (SCOPE)

Journal article

Peer reviewed

Inducible amp C beta-lactamase producing gram-negative bacilli from blood stream infections: frequency, antimicrobial susceptibility, and molecular epidemiology in a national surveillance program (SCOPE)

Michael A Pfaller, Ronald N Jones, Steven A Marshall, Stacy L Coffman, Richard J Hollis, Michael B Edmund and Richard P Wenzel

Diagnostic microbiology and infectious disease, Vol.28(4), pp.211-219

08/1997

DOI: 10.1016/S0732-8893(97)00064-3

PMID: 9327251

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Abstract

A surveillance study of nosocomial blood stream infections [Surveillance and Control of Pathogens of Epidemiologic Importance (SCOPE)] was conducted during a 14-month period in 1995 to 1996 in approximately 50 American medical centers. Among the 4725 blood stream infections, the etiologic agent was Enterobacter spp. in 230, Citrobacter freundii in 24, and Serratia marcescens in 65. The vast majority of these isolates (89%) had been sent to the University of Iowa including 198 Enterobacter spp. (46 Enterobacter aerogenes, 141 Enterobacter cloacae, 11 other Enterobacter spp.), 23 C. freundii, and 62 S. marcescens. Because these species are capable of producing Amp C beta-lactamase, we examined their susceptibility to 12 broad-spectrum antimicrobial agents. The frequency of resistance to ceftazidime and the molecular epidemiology of ceftazidime-resistant strains was also examined. Among the Enterobacter spp. and C. freundii isolates, resistance to third generation cephalosporins (ceftazidime, ceftriaxone) and broad-spectrum semisynthetic penicillins (piperacillin), with or without an enzyme inhibitor (piperacillin/tazobactam), was high, e.g., 35 to 50%. The S. marcescens isolates were quite susceptible to all agents tested. Both imipenem and cefepime were active against virtually all isolates tested including 84 stably derepressed Amp C-producing ceftazidime-resistant strains of Enterobacter spp. and C. freundii. The overall rank order of activity for the six best agents against these Amp C-producing strains was: imipenem (100% susceptible) > amikacin = cefepime (98.6%) > ciprofloxacin = gentamicin = ofloxacin (93.6 to 94.0%). Molecular typing studies of ceftazidime-resistant E. cloacae using an automated ribotyping system, as well as pulsed-field gel electrophoresis, indicated that although clonal spread of a single strain occurred in some of the medical centers, most of the episodes of bacteremia were caused by patient-unique strains. Control of these resistant organisms will require attention to microbiologic recognition of phenotypes, to infection control practices, and to limiting the overuse of certain extended spectrum beta-lactams.

Molecular Epidemiology

United States - epidemiology

Serratia marcescens - drug effects

Ceftazidime - pharmacology

Humans

Enterobacter - enzymology

Seroepidemiologic Studies

Data Collection

Bacteremia - microbiology

Gram-Negative Bacterial Infections - microbiology

Microbial Sensitivity Tests

Citrobacter freundii - drug effects

Multicenter Studies as Topic

Bacterial Typing Techniques

Bacteremia - blood

Serratia marcescens - enzymology

beta-Lactamases - metabolism

Cyclic AMP - metabolism

Cross Infection - epidemiology

Enterobacter - classification

beta-Lactamases - drug effects

Citrobacter freundii - classification

Gram-Negative Bacteria - enzymology

Drug Resistance, Microbial

Gram-Negative Bacteria - drug effects

Serratia marcescens - classification

Cross Infection - microbiology

Gram-Negative Bacterial Infections - blood

Gram-Negative Bacterial Infections - epidemiology

Bacteremia - epidemiology

Anti-Bacterial Agents - pharmacology

Citrobacter freundii - enzymology

Enterobacter - drug effects

Cross Infection - blood

Gram-Negative Bacteria - classification

Details

Title: Subtitle: Inducible amp C beta-lactamase producing gram-negative bacilli from blood stream infections: frequency, antimicrobial susceptibility, and molecular epidemiology in a national surveillance program (SCOPE)
Creators: Michael A Pfaller - Department of Pathology, University of Iowa College of Medicine, Iowa City 52242, USA
Ronald N Jones
Steven A Marshall
Stacy L Coffman
Richard J Hollis
Michael B Edmund
Richard P Wenzel
Resource Type: Journal article
Publication Details: Diagnostic microbiology and infectious disease, Vol.28(4), pp.211-219
Publisher: United States
DOI: 10.1016/S0732-8893(97)00064-3
PMID: 9327251
ISSN: 0732-8893
eISSN: 1879-0070
Language: English
Date published: 08/1997
Academic Unit: Infectious Diseases; Epidemiology; Pathology; Internal Medicine
Record Identifier: 9983905532102771

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