Escherichia coli b- Extended spectrum b-lactamase (ESBL) 8 (6.5 ), Cephalosporinase (Amp- Amp-C 2. IncF (FIA,FIB) group ESBL 6 Amp-C 4

Transcription

1 Escherichia coli b b Escherichia coli b- 4,211 E. coli 123 (2.9) 124 CAZ AZT MIC 2 mg/ml 12 (9.8) 13 Extended spectrum b-lactamase (ESBL) 8 (6.5), Cephalosporinase (Amp- C) 5 (4.1) ESBL CTX-M9 5 CTX-M1 2 1 Amp-C 5 2 CIT plasmidamp-c (p-ampc) replicon type IncF (FIA,FIB) group ESBL 6 Amp-C 4 ESBL 8 5 flomoxef 1 Amp-C 2 Key words: ESBL, p-ampc, Escherichia coli, 2004 Surviving Sepsis Campaign Guidelines (SSCG) ( ) 231 TEL: FAX: inuis@hirakata.kmu.ac.jp Escherichia coli b- b- E. coli Cephalosporinase AmpC AmpR AmpR 3 A b- extended spectrum b-lactamase (ESBL) 1) b- metallo b-lactamase (MBL) E. coli 2) Vol. 21 No

2 194 Cephalosporinase (AmpC) Cephalosporinase (p-ampc) p-ampc E. coli ) E. coli b E. coli b- 2. BBL CRYSTAL CLSI (MIC) MIC 50 MIC 90 ampicillin (ABPC), piperacillin (PIPC), piperacillin/tazobactam (P/T), cefotiam (CTM), ceftazidime (CAZ), cefozopran (CZOP), cefepime (CFPM), flomoxef (FMOX), aztreonam (AZT), sulbactam/cefoperazone (S/C), meropenem (MEPM), biapenem (BIPM), doripenem (DRPM), amikacin (AMK), tobramycin (TOB), ciprofloxacin (CPFX), pazufloxacin (PZFX) ESBL AmpC amoxicillin/clavulanic acid (ACV), ceftibuten (CETB), tebipenempivoxil (TBPM), minocycline (MINO), sitafloxacin (STFX), levofloxacin (LVFX), fosfomycin (FOM), sulfamethoxazole-trimethoprim (ST) 3. ESBL AmpC CLSI 4) CAZ AZT MIC 2 mg/ml ESBL Double Disk synergy test DDST 5) AmpC 6) DDST MacFarland 0.5 AMPC/CVA CAZ, cefotaxime (CTX), CFPM, cefpirome (CPR) 20 mm (CVA) ESBL MacFarland 0.5 CAZ CTX 2 30 mm mg/disk AmpC 4. PCR ESBL p- AmpC ESBL AmpC PCR ESBL p-ampc ESBL Johann 7) CTX- M1, CTX-M2, CTX-M8, CTX-M9 p-ampc Pérez-Pérez 8) MOX(MOX-1, MOX-2, CMY-1, CMY-8CMY-11), CIT (LAT-1LAT-4, CMY-2 CMY-7, BIL-1), DHA(DHA-1, DHA-2), ACC, EBC (MIR-1T, ACT-1), FOX (FOX-5b) 5. replicon type replicon Carattoli 9) 5 PCR 3 PCR HI1, HI2, I1-Ig, X, L/M, N, FIA, FIB, W, Y, P, FIC, A/C, T, FIIAs, F, K B/O 18 replicon type 6. ESBL random amplified polymorphic DNA(RAPD)PCR RAPDPCR Vila 10) ESBL 7. b- E. coli CAZ AZT MIC 2 mg/ml E. coli CRP, WBC, 20 Vol. 21 No

3 b- E. coli E. coli 123 (2.9)124 CAZ AZT MIC 2 mg/ml 12 (9.8) 13 ESBL 8 (6.5), AmpC 5 (4.1) 1 2. ESBL AmpC MIC 50 MIC 90 2 MIC 50 MIC 90 4 mg/ml 16 mg/ml SBT/CPZ MIC 50 /MIC mg/ml AmpC CZOP MIC 90 2 mg/ml Breakpoint CFPM MIC 50 MIC mg/ml 0.5 mg/ml ESBL 1 4 MIC 50 /MIC 90 b- SBT/CPZ FMOX MIC 50 MIC mg/ml 1 mg/ml 0.25 mg/ml 3. ESBL, p-ampc replicon type ESBL 8 AmpC 5 replicon type 3 ESBL CTX CTX-M9 5 CTX-M1 2 1 AmpC 5 2 CIT p-ampc CIT p-ampc AmpC CAZ SBT/CPZ MIC replicon type IncF (FIA, FIB) group ESBL 6 AmpC 4 MIC TBPM 0.06 mg/ml STFX LVFX FOM CIT 1 4. ESBL RAPDPCR ESBL 7 RAPDPCR 1 Case No. 1 No ESBL 8 AmpC E. coli ,211 E. coli E. coli CAZ or AZT2 mg/ml E. coli CAZ or AZT 2 mg/ml ESBL AmpC (6.5) (4.1) 1 2 (ESBL AmpC Vol. 21 No

4 MIC50/MIC90 E. coli MIC 50/90 MIC (mg/ml) ABPC PIPC P/T CTM CAZ CZOP CFPM FMOX AZT S/C MEPM BIPM DRPM AMK TOB CPFX PZFX ESBL AmpC ABPC: ampicillin, PIPC: piperacillin, P/T: piperacillin/tazobactam, CTM: cefotiam, CAZ: ceftazidime, CZOP: cefozopran, CFPM: cefepime, FMOX: flomoxef, AZT: aztreonam, S/C: sulbactam/cefoperazone, MEPM: meropenem, BIPM: biapenem, DRPM: doripenem, AMK: amikacin, TOB: tobramycin, CPFX: ciprofloxacin, PZFX: pazufloxacin 22 Vol. 21 No

5 b- E. coli ESBL AmpC MIC Case No. MIC (mg/ml) MIC (mg/ml) ESBL p-ampc Replicon ABPC PIPC CAZ CFPM FMOX AZT S/C MEPM AMK CPFX ACV CETB TBPM MINO STFX LVFX FOM ST 1 CTX-M9 FIA FIB /4 2 CTX-M9 FIB Y /4 3 CTX-M /1 4 CTX-M9 FIA /4 5 CTX-M9 FIA FIB /1 6 CTX-M1 FIB /1 7 CTX-M9 FIB /1 8 unknown unknown unknown CIT FIB /4 10 CIT I1-Ig /1 11 FIA FIB FIA FIB FIB /1 ABPC: ampicillin, PIPC: piperacillin, CAZ: ceftazidime, CFPM: cefepime, FMOX: flomoxef, AZT: aztreonam, S/C: sulbactam/cefoperazone, MEPM: meropenem, AMK: amikacin, CPFX: ciprofloxacin, ACV amoxicillin/clavulanic acid, CETB: ceftibuten, TBPM tebipenem pivoxil, MINO: minocycline, STFX: sitafloxacin, LVFX: levofloxacin, FOM: fosfomycin, ST: sulfamethoxazole-trimethoprim Vol. 21 No

6 ESBL RAPDPCR ESBL p-ampc AmpC Case No. 4 No. 12 ESBL Case No CV 8 5 Case No. 26 ESBL p-ampc AmpC 6 ESBL FMOX 1 ESBL 2 Case No. 5 MEPM Pseudomonas aeruginosa Case No. 6 CIT p-ampc 2 E. coli Ortega 11) 55 E. coli ESBL 1 8 E. coli ) ) ESBL 23.3 Tumbarello 13) ESBL E. coli ) 874 E. coli 123 (14) ESBL E. coli (6.5), AmpC (4.1) Ortega 11) ) E. coli ESBL 10 AmpC CIT (LAT-1LAT-4, CMY-2CMY-7, BIL-1) p- AmpC E. coli 16) E. coli ESBL 5.4 AmpC 3.3 ESBL CTX-M9 replicon type IncF group 24 Vol. 21 No

7 b- E. coli ESBL AmpC Case No. CRP (mg/dl) WBC (10 2 /ml) BT () CPFX (7) VRCZ (7) CFPM PAPMDRPM VANC CTMFMOX E. coli (ESBL) IPM (5) CEZ, FMOXMEPM MEPMMINO MEPMMINO FLCZFMOX PAPMCMZ /20ope 3/26ope E. coli (ESBL) SBT/CPZMEPM E. coli (ESBL) MEPMMEPM CPFX / E.coli (ESBL) CEZ BIPM, CLDM / E. coli (ESBL) SBT/CPZ (3) CLDM BIPM, CLDM IPM, CLDM CMZMEPM PIPC (1) IPM BIPMPZFX, MCFG E. coli SBT/CPZMEPM E.coli (ESBL) AMPC (8) ABPC (8) MEPMCPFXcp Vol. 21 No

8 200 E. coli Surviving Sepsis Campaign Guidelines (SSCG) ) ESBL AmpC 4 ESBL 1 FMOX AmpC FMOX ESBL ESBL 18) 1 FMOX 19) Ortega 11) CPFX,LVFX ESBL 8 4 MIC 4 mg/ml STFX ESBL p-ampc MIC STFX DNA dual inhibitory activity LVFX, CPFX 8 MFLX, GRNX 16 ESBL CPFX 32 20) ESBL 2 CV ESBL 3 21) ESBL ESBL p-ampc real time PCR CTX 1) Paterson, D. L., R. A. Bonomo Extendedspectrum betalactamases: A clinical update. Clin. Microbiol. Rev. 18: ) Shibata, N. Y. Doi, K. Yamane, et al PCR typing of genetic determinants for metallo-blactamases and integrases carried by Gramnegative bacteria isolated in Japan, with focus on the class 3 integron. J. Clin. Microbiol. 41: ) Jacoby, G. A AmpC b-lactamases. Clin. Microbiol. Rev. 22: ) Clinical and Laboratory Standards Institute Performance standards for antimicrobial susceptibility testing: 15th informational supplement. M100-S15. Clinical and Laboratory Standards Institute,Wayne, Pa. 5) Jarlier, V., M. H. Nicolas, G. Fournier, A. Philippon Extended broad-spectrum betalactamases conferring transferable resistance to newer beta-lactam agents in Enterobacteriaceae: Hospital prevalence and susceptibility patterns. Rev. Infect. 10: ) Yagi, T., J. Wachino, H. Kurokawa, et al Practical methods using boronic acid compounds for identification of class C betalactamase-producing Klebsiella pneumonia and Escherichia coli. J. Clin. Microbiol. 43: ) Johann, D., D. Pitout, A. Hossain, D. N. Hanson Phenotypic and molecular detection of CTX-M-b-lactamases produced by Escherichia 26 Vol. 21 No

9 b- E. coli 201 coli and Klebsiella spp. J. Clin. Microbiol. 42: ) Pérez-Pérez, F. J., N. D. Hanson Detection of plasmid-mediated AmpC b-lactamase genes in clinical isolates by using multiplex PCR. J. Clin. Microbiol. 40: ) Carattoli, A., A. Bertini, L. Villa, et al Identification of plasmids by PCR-based replicon typing. J. Microbiol. Methods 63: ) Vila, J., M. A. Marcods, M. T. Jimenez de Anta A comparative study of di#erent PCRbased DNA fingerprinting techniques for typing of the Acinetobacter calcoaceticusa. baurnannii complex. J. Med. Microbiol. 44: ) Ortega, M., F. Marco, A. Soriano, et al Analysis of 4758 Escherichia coli bacteraemia episodes: Predictive factors for isolation of an antibiotic-resistant strain and their impact on the outcome. J Antimicrob. Chemother. 63: ) Serefhanoglu, K., H. Turan, F. E. Timurkaynak, et al Bloodstream infections caused by ESBL-producing E. coli and K. pneumoniae: Risk factors for multidrug-resistance. The Brazilian Journal of Infectious Diseases 13: ) Tumbarello, M., M. Sali, E. M. Trecarichi, et al Bloodstream infections caused by extended-spectrum beta-lactamase-producing Escherichia coli: Risk factors for inadequate initial antimicrobial therapy. Antimicrob. Agents Chemother. 52: ) Surviving Sepsis Campaign Guidelines De-escalation. 227: ) b- 50: ) ESBL 19: ) Surviving Sepsis Campaign Guidelines De-escalation. 227: ) Extended-spectrum b-lactamase Escherichia coli 57: ) : ) : ) ESBL 53: Vol. 21 No

10 202 Studies on the Drug-Resistance of Escherichia coli Isolated from Cultured Blood to b-lactam Antibiotics Sachiko Inui, Tatsuya Nakamura, Chihiro Koike, Kazuyuki Okuda, Makoto Sano, Chiyo Nakata, Hiroko Fujimoto, Hiroe Ohkura, Hakuo Takahashi Department of Clinical Laboratory, Kansai Medical University Hirakata Hospital In recent years, the drug resistance of Gram-negative bacilli particularly beta-lactamase-producing bacteria becomes the hot topic, and it is important to know the resistant mechanism and the epidemiological di#usion. Also, cases with the resistant bacteria detected from blood cultures makes initial treatment become di$cult and is thought to a#ect the prognosis. Therefore, the cases that Escherichia coli was isolated from blood cultures in this hospital by September, 2009 from January, 2006 were analyzed about the detection situation of various beta-lactamase-producing strains and the e#ect of treatment. Onehundred twenty four strains of E. coli were detected from 123 cases (2.9) out of 4,211 blood culture specimens. Among them, 13 strains in 12 cases (9.8) had MIC of 2 mg/ml for CAZ and AZT. Thereby, 8 strains (6.5) were producing extended spectrum b-lactamase (ESBL) and 5 strains (3.3) were Cephalosporinase (Amp-C) producers. The genotype of the ESBL producing E. coli showed to be a CTX-M9 type in 5 strains, and CTX-M1 type in 2 strains. CIT-type plasmid-amp-c (p-ampc) was detected in 2 of 5 strains with the Amp-C producer. The replicon type of the plasmid gene was mostly the IncF (FIA, FIB) group, and was presented in 6 ESBL producers and 4 Amp-C producers. The antibiotic therapy was e#ective in eight ESBL producers. Thereby, carbapenems was given in 5 cases and flomoxef in 1 case. Carbapenems were used in 2 Amp-C producers. These results indicate that the MIC creep with increasing antibiotic resistance for E. coli even in this country is evident, and the appropriate defense program not only for detection of microorganism but also for treatment in clinical setting is definitely necessary. 28 Vol. 21 No