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

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An Erratum to this article was published on 09 October 2012

Abstract

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.

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Acknowledgements

To the members of the GEMARA and GEIH groups: Emilia Cercenado (Hospital Gregorio Marañon, Madrid), Beatriz Orden (CE Argüelles, CEP Madrid, Hospital Universitario Puerta del Hierro, Madrid), Andrea Mª Gonzalez and Alberto Delgado-Iribarren (Hospital Fundación de Alcorcón, Madrid), Rafael Cantón and M. Isabel Morosini (Hospital Ramon y Cajal, Madrid), Carmen Aspiroz and Blanca Fortuño (Hospital Royo Villanova, Zaragoza), Fe Tubau and Josefina Ayats (Hospital de Bellvitge, Barcelona), F. Javier Castillo and Cristina Seral (Hospital Clínico Universitario Lozano Blesa, Zaragoza), Margarita Salvador and Concepción Segura (Laboratori de Referencia, Barcelona), Cayo Sádaba and Marta Lamata (Fundación Hospital de Calahorra, La Rioja), Ana Granados and Dionisia Fontanals (Hospital Parc Taulí, Barcelona), Frederic Ballester and Oscar Villuenda (Hospital de Sant Joan de Reus, Reus), Frederic Gómez and Rafael Sánchez (Hospital Universitari Joan XXIII, Tarragona), Cristina Pitart and Francesc Marco (Hospital Clínic de Barcelona, Barcelona), Gloria Royo and Montserrat Ruíz (Hospital General Universitari d’Elx, Elx), Mª Luz Núñez and Antonio Altuna Cuesta (Hospital Reina Sofia de Murcia, Murcia), José Luis López and Miguel Salavert (Hospital Universitari La Fe, Valencia), Pilar Marín (Hospital Puerta del Mar, Cadiz), Pilar Teno (Hospital San Pedro de Alcántara, Cáceres), Patricia Iraurgui and Cecilia Martín (Hospital Virgen del Rocío, Sevilla), Gloria Esteban and Begoña Fernández (Complejo hospitalario de Ourense, Ourense), M. Isabel Fernández-Natal (Complejo Asistencial de León, León), Carlos Fuster (Hospital de El Bierzo, León), Fernando García-Garrote and Amparo Coira Nieto (Complejo Hospitalario Xeral-Calde de Lugo, Lugo), Ana Fleites and Marta Lantero (Hospital Universitario Central de Asturias, Oviedo), Andrés Canut (Hospital Santiago Apostol Osakidetza, Servicio Vasco de Salud, Basurto), Estibaliz Ugalde and Carmen Torres (Hospital San Pedro, Logroño), Mª Luz Cordón and Ainara Rodríguez (Hospital de Alto Deba, Mondragón), Mirian Alkorta and Ana María Iturzaeta (Hospital de Zumárraga, Zumárraga), Joxe Mari Manterola (Hospital de Mendaro, Mendaro).

We thank C. Newey for revising the English language in this paper.

Funding

This study was partially supported by the Ministry of Health and Consumer Affairs, Instituto de Salud Carlos III—FEDER, the Spanish Network for Research in Infectious Diseases (REIPI RD06/0008), by a grant from the Fondo de Investigación Sanitaria (PS09/00125) and by AstraZeneca Farmacéutica Spain and Wyeth (now Pfizer) pharmaceutical industries.

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The authors declare that they have no conflict of interest.

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Correspondence to F. Navarro.

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Figure S1

Prevalence of plasmid-mediated AmpC β-lactamases and carbapenemases in different Spanish Autonomous Communities (PPT 102 kb)

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Miró, E., Agüero, J., Larrosa, M.N. et al. Prevalence and molecular epidemiology of acquired AmpC β-lactamases and carbapenemases in Enterobacteriaceae isolates from 35 hospitals in Spain. Eur J Clin Microbiol Infect Dis 32, 253–259 (2013). https://doi.org/10.1007/s10096-012-1737-0

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