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Epidemiology of extended-spectrum b-lactamase-producing Enterobacteriaceae in Belgium: preliminary results of a national multicentre survey in 2006

Abstract number: 1733_852

Glupczynski Y., Berhin C., Rodriguez-Villalobos H., Struelens M., Jans on behalf of the Belgian Infection Control Society B.

Objectives: As part of a national two-yearly surveillance, we evaluated the species distribution of ESBL-producing Enterobacteriaceae (ESBLE) isolated in Belgian hospitals and the in vitro activity of 11 antimicrobials against these isolates.

Materials and Methods: Consecutive, unduplicated clinical isolates of ESBLE collected in the participating centres (maximum of 5 strains per centre) between 01/2006 and 06/2006 were sent to the reference laboratory. All strains were confirmed as ESBL producers by double combination disk test (DDT) and/or by ESBL E-tests (cefotaxime and ceftazidime + clavulanic acid). The presence of ESBL among AmpC hyperproducers was assessed by DDT in the presence of cloxacillin 500 mg disks or on cloxacillin (250 mg/mL) agar. E-test MICs were determined and results were interpreted according to CLSI and EUCAST clinical MIC breakpoints.

Results: 86 hospitals (regional distribution: 42 from Flanders, 29 from Wallonia and 15 from Brussels) sent 401 potential ESBLE isolates. Of these, 330 (82%) were confirmed as ESBL producers. The ESBLE strains originated from patients (mean age 72 years; range 1–97 years) hospitalised in medical wards (39%), ICU (21%), geriatric or surgical units (13% each); they were mainly isolated from urinary (50%) and respiratory tracts (25%), wound swabs (19%) and blood (3%). Enterobacter aerogenes (Ea), Escherichia coli (Ec) and Klebsiella pneumoniae were the most frequent ESBLE and represented respectively 44%, 39% and 9% of all isolates. 72% of all ESBLE were considered as nosocomially acquired; however almost 50% of Ec ESBL producers were deemed to be community-acquired.

97% of all ESBLE were resistant to ceftazidime, 86% to cefotaxime, and 78% to ciprofloxacin. Carbapenems (meropenem, imipenem) were the most active agents (98–99% susceptibility) followed by temocillin (93% susceptibility), gentamicin and amikacin (85% susceptibility each) and tigecycline (82% susceptibility). Higher resistance rates and co-resistance to ceftazidime and ciprofloxacin were observed among Ea while almost two-third of the Ec ESBL producers had a resistance phenotype compatible with CTX-M ESBLs. Most Ec strains originated from urines of elderly patients and were co-resistant to ciprofloxacin.

Conclusions: These in vitro data provide new insights in the epidemiology of resistance among Belgian ESBLE isolates and highlight the rising importance of community-acquired ESBLs, especially among Ec strains.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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