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Volume 7, Number 5—October 2001
Research

Rapid Emergence of Ciprofloxacin-Resistant Enterobacteriaceae Containing Multiple Gentamicin Resistance-Associated Integrons, the Netherlands

Alex van BelkumComments to Author , Wil Goessens, Cindy van der Schee, Nicole Lemmens-den Toom, Margreet C. Vos, Jan Cornelissen, Elly Lugtenburg, Siem de Marie, Henri Verbrugh, Bob Löwenberg, and Hubert Endtz
Author affiliations: Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands

Main Article

Table 1

Survey of epidemiologic and genetic data for the ciprofloxacin-resistant enterobacteriaceae isolated in the three hematology wards

Patient Date of Integron tests Aminoglycoside
strain no.
Material
 isolation
Dept.
Size
RFLP
PFGE
Res. type
enzyme
Enterobacter cloacae
1-1 fc 12-30-98 A A SL
2-1 bc 10-23-99 C 2,000/2,200 A B CGTASL E
2-2 bc 10-23-99 C A B CGTASL E
3-1 re 07-13-99 A C SL
3-2 re 08-05-99 A C SL
3-3 ur 08-11-99 A C SL
3-4 re 10-04-00 A C SL
4-1 re 06-07-99 A C SL
4-2 re 06-21-99 A C SL
5-1 re 02-01-99 B 2,000 B D CGTSE
5-2 re 02-04-99 B 2,000 B D GTS E
5-3 ur 02-04-99 B 2,000 B D GS BCDE
5-4 re 02-08-99 B 2,000 -- E GTS E
6-1 re 07-05-99 A -- -- C SL
6-2 re 07-26-99 A -- -- C SL
6-3 ur 07-27-99 A -- -- C SL
6-4 -- -- A -- -- C SL
7-1 fc 12-18-98 A 2,000/2,200 A F GSL B
7-2 re 12-21-98 A 2,000/2,200 A G GCTAS B
8-1 re 06-28-99 A C SL E
8-2 ur 06-28-99 A C SL
9-1 fc 01-15-99 A H --
9-2 fc 01-18-99 A H S
9-3 fc 01-21-99 A H S
9-4 fc 01-25-99 A H S
9-5 fc 01-28-99 A H CS
10-1 re 04-19-99 B 2,000 B E GTS E
11-1 re 06-07-99 C 2,000/2,200 A B CGTASL E
11-2 re 06-18-99 C 2,000 B I CGTAL E
11-3 re 06-21-99 C 2,000/2,200 A J CGTASL D
11-4 re 07-05-99 C 2,000/2,200 A B CGTASL
11-5 we 07-11-99 C 2,000/2,200 A B CGTASL
11-6 re 07-12-99 C 2,000/2,200 A B CGTASL
11-7 ur 08-04-99 C 2,000/2,200 A B
12-1 fc 12-26-98 A C SL
12-2 sk 01-15-99 A C SL
12-3 wd 01-15-99 A C CSL
12-4 fc 01-18-99 A C SL
13-1 fc 03-08-99 C 2,000/2,200 A B CGTAE
13-2 ur 03-09-99 C 2,000/2,200 A K CGTSE
13-3 fc 03-15-99 C 2,000/2,200 A B CGTSL E
13-4 ur 03-16-99 C 2,000/2,200 A Q CGTASL F
13-5 re 03-22-99 C 2,000/2,200 A J CGTSL E
14-1 ur 08-05-99 A -- --
15-1 re 07-26-99 C 2,000/2,200 A L CGTASL E
15-2 re 08-02-99 C 2,000/2,200 A M CGTASL E
15-3 fc 08-06-99 C 2,000/2,200 A M CGTASL
15-4 re 08-26-99 C 2,000/2,200 A M CGTASL
15-5 re 08-30-99 C 2,000/2,200 A ? CGTASL E
15-6 -- -- C 2,000/2,200 A N CGTASL E
15-7 re 09-03-99 C 2,000/2,200 A M CGTASL E
15-8 re 09-06-99 C 2,000/2,200 A L CGTASL E
15-9 re 09-30-99 C 2,000/2,200 A L CGTASL
16-1 re 06-21-99 A C SL
17-1 re 09-17-99 B 2,000/2,200 A P CGTS E
18-1 bc -- -- 2,000/2,200 A M
Escherichia coli
1-1 bc 12-31-98 A 2,000 - L S
20-1 re 10-07-99 B M
20-2 re 10-11-99 B M
20-3 re 10-18-99 B M
21-1 fc 11-19-98 B 1,000/1,800 C L GTS AB
21-2 fc 11-12-98 B 1,000/1,800 C L GTS
21-3 fc 11-15-98 B 1,000/1,800 C L GTS
21-4 fc 11-17-98 B 1,000/1,800 C L GTS
21-5 fc 11-17-98 B 1,000/1,800 C L GTS AB
22-1 fc 01-04-98 A 2,700 D N TS
22-2 re 01-11-99 A 2,700 D N TS
22-3 re 02-25-99 B 2,700 D N S
22-4 ur 02-25-99 B 2,700 D N TS
22-5 re 04-06-99 B 2,700 D N TS
22-6 re 04-06-99 B 2,700 D N TS
23-1 re 09-04-99 A 1,800 E O GTS AB
23-2 re 09-06-99 A 1,800 E O GTS
23-3 re 09-13-99 A 1,800 E O GTS
23-4 re 09-27-99 A 1,800 E O GTS
23-5 ur 10-21-99 A 1,800 E O GTS AB
24-1 re 09-26-99 A 1,500 F A GS ABCD
24-2 re 10-11-99 A 1,500 F A GS
25-1 fc 01-11-99 A J S
25-2 fc 01-13-99 B K S
26-1 re 10-11-99 B 1,500 F I GTS ABCDE
27-1 ur 03-09-00 C G S
27-2 -- -- C G S
27-3 ur 03-10-99 C H S
27-4 -- -- C H S
27-5 ur 03-22-99 C H S
27-6 ur 03-25-99 C C S
28-1 re 02-01-99 C --
28-2 ur 02-01-99 C A
28-3 ur 02-15-99 C 1,500 F A GS BCD
28-4 va 02-27-99 C 1,500 F A GS ABCD
28-5 ur 03-15-99 C 1,500 F A GS
29-1 tr 02-01-99 A 1,500 G A GS ABCD
29-2 tr 02-08-99 A B CG CD
29-3 tr 02-23-99 B 1,500 G A GS
30-1 ur 12-07-99 A 1,000/1,300/1500 I A GS
30-2 fc 12-10-98 A 2,700 D C S F
30-3 fc 12-10-98 A 1,000/1,300/1500 I D -
31-1 fc 12-07-98 B 1,500/2,000 G A S F
32-1 re 02-11-99 A 1,800 F A CS
32-2 re 02-22-99 A 1,800 F A CS
32-3 re 03-01-99 A 1,800 F A CS F
32-4 cx 03-23-99 A 1,800 F A S
33-1 bc 11-05-99 C 2,000 J A S
34-1 bc 06-21-99 A E GS AB
35-1 ur 09-23-99 A 1,800 ? F GTS AB

Clinical materials from which the samples were derived were feces (fc), blood (bc), rectal swabs (re), urine (ur), wounds (wd), skin (sk), vaginal swabs (va) or cervical swabs (cx). All strains were resistant to ciprofloxacin, additional antibiotics tested to determine the antibiogram were ceftazidime (C), gentamicin (G), tobramycin (T), amikacin (A), cotrimoxazole (S), imipenem (I) and colistin (L). The nature of the aminoglycoside modifying enzymes involved was only tested for those strains for which a result is mentioned. Enzymes are encoded as follows: A: resistant aminoglycoside acetyl transferase AAC(3)-II; B: resistant aminoglycoside nucleotidyl transferase ANT(2"); C: heterogeneous aminoglycoside phosphotransferase APH(3') + AAC(3)-I; D: resistant AAC(3)-I; E: AAC(6'); F: resistant APH(3').

Main Article

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