Volume 7, Number 5—October 2001
Research
Rapid Emergence of Ciprofloxacin-Resistant Enterobacteriaceae Containing Multiple Gentamicin Resistance-Associated Integrons, the Netherlands
Alex van Belkum
, 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
, 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
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').
Page created: April 26, 2012
Page updated: April 26, 2012
Page reviewed: April 26, 2012
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.