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ABSTRACT: Most Escherichia coli resistant to quinolones are not haemolytic. The objective of this study was to determine the phylogroup, clonal relationship, mechanism of quinolone resistance and virulence factors in 70 haemolytic E. coli resistant to nalidixic acid. Sixty-six isolates contained the hlyA gene, belonged to phylogroup B2, and 61 of them presented low-level resistance to fluoroquinolones. Four isolates presented high-level resistance to fluoroquinolones, contained the clyA gene and were included in phylogroup D. One single isolate (phylogroup D, with low level resistance to fluoroquinolones) contained both cytotoxins.
SpringerPlus. 12/2013; 2(1):71.
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Jesús Rodríguez-Baño,
Jesús Oteo,
Adriana Ortega,
Macarena Villar,
M Carmen Conejo,
Germán Bou,
Maitane Aranzamendi-Zaldumbide,
Emilia Cercenado,
Mercè Gurguí, Luis Martínez-Martínez,
María Merino,
Alba Rivera,
Antonio Oliver,
Irene Weber,
Alvaro Pascual,
Rosa M Bartolomé,
Juan José Gónzalez-López,
José Campos
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ABSTRACT: Two hundred and twelve patients with colonization/infection due to amoxicillin-clavulante (AMC)-resistant Escherichia coli were studied. OXA-1 and IRT producers were associated with urinary tract infections, while OXA-1 producers and chromosomal AmpC hyperproducers were associated with bacteremic infections. AMC resistance in E. coli is a complex phenomenon with heterogeneous clinical implications.
Journal of clinical microbiology 05/2013; · 4.16 Impact Factor
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ABSTRACT: BACKGROUND: The prevalence and type of plasmids, resistance genes and integrons carried by two collections of multiresistant E. coli producing or not extended-spectrum beta-lactamases have been compared. Rep-PCR was used to determine the clonal relationship of the organisms. Plasmids were classified according to their incompatibility. Class 1 and Class 2 integrons and antibiotic resistance genes were analysed by PCR and sequencing. RESULTS: Both collections of organisms contained a large diversity of unrelated strains with some clones distributed in both groups of isolates. Large plasmids were identified in the two groups of organisms. Plasmids with replicons repK and repColE were more frequent among ESBL-producing isolates, while repFIA, repFII and repA/C replicons were more frequent in isolates lacking ESBL. Conjugative plasmids with repK and repA/C replicons coded for CTX-M-14 and CMY-2 beta-lactamases, respectively. No significant differences were observed in the distribution of class 1 and class 2 integrons among multiresistant E. coli producing or not ESBL, and dfrA17-ant(3[prime][prime])-Ie was the cassette arrangement most commonly found. CONCLUSIONS: In the concrete temporal and geographical context of this study, multiresistant E. coli producing ESBL or other mechanisms of resistance were largely clonally diverse and present some differences in the types of harboured plasmids. Still, some clones were found in both ESBL-producing and --lacking isolates.
BMC Microbiology 04/2013; 13(1):84. · 3.04 Impact Factor
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Gabriel Cabot,
Alain A Ocampo-Sosa,
M Angeles Domínguez,
Juan F Gago,
Carlos Juan,
Fe Tubau,
Cristina Rodríguez,
Bartolomé Moyà,
Carmen Peña, Luis Martínez-Martínez,
Antonio Oliver
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ABSTRACT: Recent reports have revealed the existence of widespread extensively drug-resistant (XDR) P. aeruginosa high-risk clones in health care settings, but there is still scarce information on their specific chromosomal (mutational) and acquired resistance mechanisms. Up to 20 (10.5%) of 190 bloodstream isolates collected from 10 Spanish hospitals met the XDR criteria. A representative number (15 per group) of isolates classified as multidrug-resistant (MDR) (22.6%), resistant to 1-2 classes (modR) (23.7%), or susceptible to all antibiotics (multiS) (43.2%) were investigated in parallel. MLST analysis revealed that all XDR isolates belonged to ST175 (n=19) or ST111 (n=1), both recognized as international high-risk clones. Clonal diversity was higher among the 15 MDR isolates (4 ST175, 2 ST111, and 8 additional STs) and especially among the 15 modR (13 different STs) and multiS (14 STs) isolates. The XDR/MDR pattern in ST111 isolates correlated with the production of VIM-2, but none of the ST175 isolates produced acquired β-lactamases. In contrast, the analysis of resistance markers in 12 representative isolates (from 7 hospitals) of ST175 revealed that the XDR pattern was driven by the combination of AmpC hyperproduction, OprD inactivation (Q142X), 3 mutations conferring high-level fluoroquinolone resistance (GyrA T83I and D87N and ParC S87W), a G195E mutation in MexZ (involved in MexXY-OprM overexpression), and the production of a class 1 integron harboring the aadB gene (gentamicin and tobramycin resistance). Of particular interest, in nearly all the ST175 isolates, AmpC hyperproduction was driven by a novel AmpR-activating mutation (G154R), as demonstrated by complementation studies using an ampR mutant of PAO1. This work first describes the specific resistance markers of widespread P. aeruginosa XDR high-risk clones producing invasive infections.
Antimicrobial Agents and Chemotherapy 10/2012; · 4.84 Impact Factor
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ABSTRACT: OBJECTIVES: To determine the prevalence of resistance to antimicrobials in Acinetobacter baumannii (A. baumannii) from Spain and to compare it with those obtained in the first national study (GEIH-Ab project 2000). METHODS: A total of 446 isolates of A. baumannii obtained from 43 Spanish hospitals during February-March 2010 were studied. Identification of A. baumannii was confirmed by ARDRA and MALDI-TOF. Susceptibility to 18 antimicrobial agents was determined by microdilution (Clinical and Laboratory Standards Institute, CLSI). The CLSI break-points were used, except for doripenem, rifampin, sulbactam (Societé Française de Microbiologie [SFM] break-points) and tigecycline (European Committee on Antimicrobial Susceptibility Testing [EUCAST] break-points for Enterobacteriaceae). RESULTS: The percentage of resistant isolates (intermediate susceptible plus resistant) was: > 94% (ceftazidime, piperacillin and ciprofloxacin), 82-86% (carbapenems, tetracycline), 60-70% (tobramycin, sulbactam, gentamicin, doxycycline), 49% (amikacin), 30% (minocycline, rifampin), 24% (tigecycline), and 3% (colistin). These isolates were, in comparison with those of the first study, more resistant (P < .01) to ceftazidime (99% vs 83%), carbapenems (82-86% vs 43-48%), sulbactam (65% vs 53%) and colistin (3% vs 0%), but more susceptible to aminoglycosides (particularly gentamicin: 70% vs 96% of resistant isolates), tetracycline (83% vs 91%) and rifampicin (30% vs 51%). CONCLUSION: There is a high prevalence of A. baumannii resistant to antimicrobials, particularly to carbapenems. The resistance to carbapenems, ceftazidime and sulbactam was significantly higher than that observed for isolates from the GEIH-Ab project 2000. The resistance to aminoglycosides, tetracycline and rifampin, however, was significantly decreased.
Enfermedades Infecciosas y Microbiología Clínica 08/2012; · 1.49 Impact Factor
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ABSTRACT: The objective of this study was to identify risk factors for the acquisition of Acinetobacter baumannii with phenotypic heterogeneous resistance (PHR) to carbapenems and to determine whether these factors are similar to those associated with A. baumannii not showing this phenotype. Microbiological and clinical data from 211 patients included in the GEIH-Ab 2000 project were used. Isolates of A. baumannii were studied for their susceptibility to imipenem (IPM) by microdilution and for PHR to IPM as determined by the presence of colonies growing within the inhibition zone of IPM disks. Isolates were divided into three groups: (i) IPM-PHR isolates, i.e. susceptible and non-susceptible A. baumannii displaying PHR to IPM; (ii) non-IPM-PHR isolates, i.e. susceptible A. baumannii showing an inhibition halo but no colonies growing within it; and (iii) IPM-FR isolates, i.e. fully resistant A. baumannii displaying no halo of inhibition. IPM-PHR isolates of A. baumannii were more commonly isolated from respiratory tract samples and less commonly from urine, and were more frequently causes of infection than were IPM-FR isolates. Independent risk factors identified in patients with IPM-PHR isolates were Intensive Care Unit admission, surgery, and previous use of piperacillin/tazobactam or carbapenems, whilst risk factors for IPM-FR and IPM-PHR were previous use of cephalosporins and isolation from a urine sample. In conclusion, risk factors associated with colonisation/infection by isolates of A. baumannii with PHR to carbapenems are similar to those previously described for isolates resistant to carbapenems.
International journal of antimicrobial agents 07/2012; 40(3):235-8. · 3.03 Impact Factor
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ABSTRACT: Bordetella bronchiseptica rarely infects immunocompetent humans. We report an unusual case of recurrent pertussis-like syndrome caused by B. bronchiseptica in a 7-month-old immunocompetent boy. Molecular analysis demonstrated that the isolates from the child and mother were identical.
The Pediatric Infectious Disease Journal 05/2012; 31(9):981-3. · 3.58 Impact Factor
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Adriana Ortega,
Jesús Oteo,
Maitane Aranzamendi-Zaldumbide,
Rosa M Bartolomé,
Germán Bou,
Emilia Cercenado,
M Carmen Conejo,
Juan José González-López,
Mercedes Marín, Luis Martínez-Martínez,
María Merino,
Ferran Navarro,
Antonio Oliver,
Alvaro Pascual,
Alba Rivera,
Jesús Rodríguez-Baño,
Irene Weber,
Belén Aracil,
José Campos
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ABSTRACT: We conducted a prospective multicenter study in Spain to characterize the mechanisms of resistance to amoxicillin-clavulanate (AMC) in Escherichia coli. Up to 44 AMC-resistant E. coli isolates (MIC ≥ 32/16 μg/ml) were collected at each of the seven participant hospitals. Resistance mechanisms were characterized by PCR and sequencing. Molecular epidemiology was studied by pulsed-field gel electrophoresis (PFGE) and by multilocus sequence typing. Overall AMC resistance was 9.3%. The resistance mechanisms detected in the 257 AMC-resistant isolates were OXA-1 production (26.1%), hyperproduction of penicillinase (22.6%), production of plasmidic AmpC (19.5%), hyperproduction of chromosomic AmpC (18.3%), and production of inhibitor-resistant TEM (IRT) (17.5%). The IRTs identified were TEM-40 (33.3%), TEM-30 (28.9%), TEM-33 (11.1%), TEM-32 (4.4%), TEM-34 (4.4%), TEM-35 (2.2%), TEM-54 (2.2%), TEM-76 (2.2%), TEM-79 (2.2%), and the new TEM-185 (8.8%). By PFGE, a high degree of genetic diversity was observed although two well-defined clusters were detected in the OXA-1-producing isolates: the C1 cluster consisting of 19 phylogroup A/sequence type 88 [ST88] isolates and the C2 cluster consisting of 19 phylogroup B2/ST131 isolates (16 of them producing CTX-M-15). Each of the clusters was detected in six different hospitals. In total, 21.8% of the isolates were serotype O25b/phylogroup B2 (O25b/B2). AMC resistance in E. coli is widespread in Spain at the hospital and community levels. A high prevalence of OXA-1 was found. Although resistant isolates were genetically diverse, clonality was linked to OXA-1-producing isolates of the STs 88 and 131. Dissemination of IRTs was frequent, and the epidemic O25b/B2/ST131 clone carried many different mechanisms of AMC resistance.
Antimicrobial Agents and Chemotherapy 04/2012; 56(7):3576-81. · 4.84 Impact Factor
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ABSTRACT: The objectives of this study were to determine the prevalence of Acinetobacter baumannii with phenotypic heterogeneous resistance (PHR) to carbapenems (colonies inside the halo of inhibition) and to analyse its association with several microbiological variables. Acinetobacter baumannii isolates collected in Spain were used to analyse: (i) minimum inhibitory concentrations (MICs) of carbapenems; (ii) heteroresistance to carbapenems; (iii) genes encoding β-lactamases (bla genes); (iv) insertion sequences; and (v) inactivation of genes encoding porins (CarO, OprD and Omp33-36) and genes associated with the AdeABC efflux system (adeB, adeR and adeS). Polymerase chain reaction (PCR) amplification was used for gene detection. The rate of PHR was 20% to imipenem and 24% to meropenem. Susceptibility to imipenem was observed in 39% of PHR isolates. MICs of carbapenems for colonies were similar (± 1 log(2) dilution) to those of their parental isolates. These colonies growing inside the inhibition halo also reproduced the PHR to carbapenems. Differences observed between PHR isolates and non-PHR isolates were: bla(OXA-58-like), 57% vs. 0%; oprD-like, 96% vs. 56%; adeB, 89% vs. 94%; adeR, 82% vs. 94%; adeS, 82% vs. 94%; ISAba2, 61% vs. 31%; and ISAba3, 57% vs. 0%. No interruption of genes encoding porins or the efflux-related genes (adeB, adeR and adeS) was observed. In conclusion, A. baumannii strains with PHR to carbapenems are widespread in Spain. This phenotype is present in carbapenem-susceptible isolates as well as those that are not susceptible to carbapenems. Heteroresistance cannot explain the PHR to carbapenems, which appears to relate more to persistence or tolerance to carbapenems. bla(OXA-58-like), bla(OXA-51-like), ISAba2 and ISAba3 are associated with PHR to carbapenems. Inactivation of genes encoding porins or genes related to AdeABC is infrequent.
International journal of antimicrobial agents 03/2012; 39(6):472-7. · 3.03 Impact Factor
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Jordi Vila,
Pedro Juiz,
Carlos Salas,
Manel Almela,
Celia García de la Fuente,
Yuliya Zboromyrska,
Jesús Navas,
Jordi Bosch,
Jesús Agüero,
Jorge Puig de la Bellacasa, Luis Martínez-Martínez
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ABSTRACT: The identification of 83 Corynebacterium, 13 Arcanobacterium haemolyticum, and 10 Rhodococcus equi strains by conventional methods (API Coryne complemented with 16S rRNA gene sequence analysis) was compared with matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry identification. The correlation between API and MALDI-TOF results was 89%. MALDI-TOF is a rapid and accurate system for identification of the above-mentioned microorganisms.
Journal of clinical microbiology 02/2012; 50(5):1745-7. · 4.16 Impact Factor
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Alain A Ocampo-Sosa,
Gabriel Cabot,
Cristina Rodríguez,
Elena Roman,
Fe Tubau,
María D Macia,
Bartolomé Moya,
Laura Zamorano,
Cristina Suárez,
Carmen Peña,
María A Domínguez,
Gabriel Moncalián,
Antonio Oliver, Luis Martínez-Martínez
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ABSTRACT: We investigated the presence of OprD mutations in 60 strains of metallo-ß-lactamase-negative Pseudomonas aeruginosa intermediately susceptible (IS [n = 12]; MIC = 8 μg/ml) or susceptible (S [n = 48]; MICs ≤ 1 to 4 μg/ml) to imipenem and/or meropenem that were isolated from patients with bacteremia in order to evaluate their impact on carbapenem susceptibility profiles. The presence of mutations in oprD was detected by sequencing analysis. OprD expression was assessed by both outer membrane protein (OMP) analysis and real-time PCR (RT-PCR). Fourteen (23%) isolates had an OprD identical to that of PAO1, and OprD modifications were detected in 46 isolates (77%). Isolates were classified as OprD "full-length types" (T1 [n = 40, including both wild-type OprD and variants showing several polymorphisms]) and OprD "deficient types" (T2 [n = 3 for OprD frameshift mutations] and T3 [n = 17 for premature stop codons in oprD]). RT-PCR showed that 5 OprD type T1 isolates presented reduced transcription of oprD (0.1- to 0.4-fold compared to PAO1), while oprD levels increased more than 2-fold over that seen with PAO1 in 4 OprD type T1 isolates. A total of 50% of the isolates belonging to OprD "deficient types" were susceptible to both carbapenems, and 40% were susceptible to meropenem and intermediately susceptible to imipenem. Only one isolate (5%) within this group was intermediately susceptible to both carbapenems, and one (5%) was susceptible to imipenem and intermediately susceptible to meropenem. We concluded that OprD inactivating mutations in clinical isolates of P. aeruginosa are not restricted only to carbapenem-resistant isolates but are also found in isolates with imipenem or meropenem MICs of only 0.06 to 4 μg/ml.
Antimicrobial Agents and Chemotherapy 01/2012; 56(4):1703-13. · 4.84 Impact Factor
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ABSTRACT: To characterize the location and genetic environments of qnr, aac(6')-Ib-cr and qepA genes related to quinolone resistance in 19 Escherichia coli, Klebsiella pneumoniae and Klebsiella oxytoca strains.
Genetic environments of the indicated genes were studied by cloning, PCR mapping and sequencing. The location of these genes was analysed by S1-PFGE and PFGE-I-CeuI and hybridization with specific probes. Associated antibiotic resistance mechanisms and molecular typing of strains were also investigated.
The studied strains carried the aac(6')-Ib-cr, qepA, qnrS1, qnrB6, qnrB4 and oqxAB genes, with aac(6')-Ib-cr being the most prevalent. E. coli strains belonged to sequence types (STs) ST648, ST131, ST224 and ST205, and K. pneumoniae strains to ST433, ST341, ST152, ST15 and ST431. Different genetic environments of quinolone resistance genes were observed, and some of them had not been previously detected and registered in GenBank. The aac(6')-Ib-cr gene was mainly located in class 1 integrons or associated with the Tn1721 transposon in E. coli and associated with the aac(3)-II gene in Klebsiella. All these structures contained mechanisms of gene acquisition and/or dissemination, such as IS26. The studied quinolone resistance genes were mostly detected in IncF and IncN plasmids in E. coli and in IncR plasmids in Klebsiella, but in some strains the chromosomal location of the aac(6')-Ib-cr gene was detected for the first time. The bla(CTX-M-15), bla(OXA-1), tet(A), aac(3)-II and aph(3')-Ia genes and class 1 integrons were found in most strains.
The aac(6')-Ib-cr gene was detected for the first time in the chromosome, although a plasmidic location was the most frequently found, with differentiation of plasmids types in E. coli versus Klebsiella.
Journal of Antimicrobial Chemotherapy 01/2012; 67(4):886-97. · 5.07 Impact Factor
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ABSTRACT: The aim of this study was to assess the phenotypic and genotypic diversity of 56 Arcanobacterium haemolyticum isolates isolated from 51 patients attending primary health care centres and emergency units in the health area of Santander (Cantabria, northern Spain). Phenotypic characterization was based on morphological, biochemical, and antigenic tests. Species identification was confirmed by amplification and sequencing of the 16S rDNA gene. Antimicrobial susceptibility testing was determined by microdilution following the Clinical and Laboratory Standards Institute recommendations for coryneform bacteria. Genetic diversity was evaluated using BOX-PCR and pulsed-field gel electrophoresis. Eighty percent of the isolates had an identical BOX-PCR pattern, suggesting the spread of a single clone. The present report provides extensive information on the phenotypic and genotypic characterization of A. haemolyticum.
Diagnostic microbiology and infectious disease 01/2012; 72(1):1-7. · 2.45 Impact Factor
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Carmen Peña,
Cristina Suarez,
Mónica Gozalo,
Javier Murillas,
Benito Almirante,
Virginia Pomar,
Manuela Aguilar,
Ana Granados,
Esther Calbo,
Jesús Rodríguez-Baño,
Fernando Rodríguez,
Fe Tubau, Luis Martínez-Martínez,
Antonio Oliver
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ABSTRACT: The impact of antimicrobial resistance on clinical outcomes is the subject of ongoing investigations, although uncertainty remains about its contribution to mortality. We investigated the impact of carbapenem resistance on mortality in Pseudomonas aeruginosa bacteremia in a prospective multicenter (10 teaching hospitals) observational study of patients with monomicrobial bacteremia followed up for 30 days after the onset of bacteremia. The adjusted influence of carbapenem resistance on mortality was studied by using Cox regression analysis. Of 632 episodes, 487 (77%) were caused by carbapenem-susceptible P. aeruginosa (CSPA) isolates, and 145 (23%) were caused by carbapenem-resistant P. aeruginosa (CRPA) isolates. The median incidence density of nosocomial CRPA bacteremia was 2.3 episodes per 100,000 patient-days (95% confidence interval [CI], 1.9 to 2.8). The regression demonstrated a time-dependent effect of carbapenem resistance on mortality as well as a significant interaction with the Charlson index: the deleterious effect of carbapenem resistance on mortality decreased with higher Charlson index scores. The impact of resistance on mortality was statistically significant only from the fifth day after the onset of the bacteremia, reaching its peak values at day 30 (adjusted hazard ratio for a Charlson score of 0 at day 30, 9.9 [95% CI, 3.3 to 29.4]; adjusted hazard ratio for a Charlson score of 5 at day 30, 2.6 [95% CI, 0.8 to 8]). This study clarifies the relationship between carbapenem resistance and mortality in patients with P. aeruginosa bacteremia. Although resistance was associated with a higher risk of mortality, the study suggested that this deleterious effect may not be as great during the first days of the bacteremia or in the presence of comorbidities.
Antimicrobial Agents and Chemotherapy 12/2011; 56(3):1265-72. · 4.84 Impact Factor
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Journal of Antimicrobial Chemotherapy 11/2011; 67(3):776-8. · 5.07 Impact Factor
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ABSTRACT: Two closely related Enterobacter aerogenes isolates presented a new identical aac(6')-Ib-cr genetic environment, including IS26. One isolate showed lower MICs of ciprofloxacin, norfloxacin, tobramycin, and amikacin and decreased expression of aac(6')-Ib-cr, which might be related to a 12-bp deletion causing a displacement of the -10 box upstream of the aac(6')-Ib-cr gene.
Antimicrobial Agents and Chemotherapy 11/2011; 56(2):1097-100. · 4.84 Impact Factor
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ABSTRACT: There is limited information on the role of penicillin-binding proteins (PBPs) in the resistance of Acinetobacter baumannii to β-lactams. This study presents an analysis of the allelic variations of PBP genes in A. baumannii isolates. Twenty-six A. baumannii clinical isolates (susceptible or resistant to carbapenems) from three teaching hospitals in Spain were included. The antimicrobial susceptibility profile, clonal pattern, and genomic species identification were also evaluated. Based on the six complete genomes of A. baumannii, the PBP genes were identified, and primers were designed for each gene. The nucleotide sequences of the genes identified that encode PBPs and the corresponding amino acid sequences were compared with those of ATCC 17978. Seven PBP genes and one monofunctional transglycosylase (MGT) gene were identified in the six genomes, encoding (i) four high-molecular-mass proteins (two of class A, PBP1a [ponA] and PBP1b [mrcB], and two of class B, PBP2 [pbpA or mrdA] and PBP3 [ftsI]), (ii) three low-molecular-mass proteins (two of type 5, PBP5/6 [dacC] and PBP6b [dacD], and one of type 7 (PBP7/8 [pbpG]), and (iii) a monofunctional enzyme (MtgA [mtgA]). Hot spot mutation regions were observed, although most of the allelic changes found translated into silent mutations. The amino acid consensus sequences corresponding to the PBP genes in the genomes and the clinical isolates were highly conserved. The changes found in amino acid sequences were associated with concrete clonal patterns but were not directly related to susceptibility or resistance to β-lactams. An insertion sequence disrupting the gene encoding PBP6b was identified in an endemic carbapenem-resistant clone in one of the participant hospitals.
Antimicrobial Agents and Chemotherapy 09/2011; 55(12):5907-13. · 4.84 Impact Factor
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Enfermedades Infecciosas y Microbiología Clínica 09/2011; 29(10):785-6. · 1.49 Impact Factor
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ABSTRACT: The accuracy of the MicroScan WalkAway, BD Phoenix, and Vitek-2 systems for susceptibility testing of quinolones and aminoglycosides against 68 enterobacteria containing qnrB, qnrS, and/or aac(6 ')-Ib-cr was evaluated using reference microdilution. Overall, one very major error (0.09%), 6 major errors (0.52%), and 45 minor errors (3.89%) were noted.
Journal of clinical microbiology 07/2011; 49(9):3343-5. · 4.16 Impact Factor
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ABSTRACT: The microbiology characteristics of three clones of multiresistant E. coli isolated from preterm newborns admitted in a neonatal intensive care unit where quinolones are not used are described. All isolates were resistant to nalidixic acid, with MICs of ciprofloxacin ranging 1-64 mg/l, due to chromosomal mutations in topoisomerase genes. Resistance to ampicillin, gentamicin and/or sulfametoxazole was related to large conjugative plasmids of incompatibility groups N, F, and/or I1. All isolates contained the virulence genes iutA and fimH, and additional virulence genes depending on the considered clone.
Journal of Medical Microbiology 06/2011; 60(Pt 11):1713-6. · 2.50 Impact Factor
