Objective To characterise commensal Escherichia coli and other Enterobacteriaceae with reduced susceptibility to cefotaxime that were collected in a large survey carried out among 3995 patients and healthy persons in two urban regions on Java, Indonesia, in 2001-2002. Methods The putative extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae were analysed using double-disk synergy tests, isoelectric focusing, PCR assays, DNA sequencing, and pulsed-field gel electrophoresis (PFGE). Results On the day of discharge after five or more days of hospitalisation, at least 95 of 999 (9.5%) patients carried ESBL-positive Enterobacteriaceae as dominant faecal flora. Six patients were simultaneously colonised with E. coli and Klebsiella pneumoniae isolates with ESBL activity. On admission, only 6 of 998 (0.6%) patients were colonised. Faecal carriage of ESBL-producing Enterobacteriaceae among healthy persons or persons visiting a public health centre was not detected. The 107 ESBL-positive strains included 68 E. coli, 35K. pneumoniae, and four other Enterobacteriaceae. blaCTX-M-15 was the most prevalent ESBL in both E. coli (47.1%) and K. pneumoniae (45.7%), but the E. coli O25b-ST131 clone was virtually absent. Other ESBL types found were: SHV-2, -2a, -5, -12, CTX-M-3, -9, -14, and TEM-19. PFGE revealed extensive genetic diversity among the isolates. Conclusions In 2001-2002, faecal carriage of ESBL-producing Enterobacteriaceae as dominant flora in Indonesia was almost exclusively hospital-associated. The presence of various blaESBL genes and the extensive genetic diversity among isolates argue against a single/dominant strain outbreak.

Antibiotic resistance, Asia, Colonisation, CTX-M-15, ESBL
dx.doi.org/10.1111/j.1365-3156.2011.02949.x, hdl.handle.net/1765/61381
Tropical Medicine & International Health
Department of Medical Microbiology and Infectious Diseases

Severin, J.A, Lestari, E.S, Kloezen, W, Lemmens-den Toom, N, Mertaniasih, N.M, Kuntaman, K, … Goessens, W.H.F. (2012). Faecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae among humans in Java, Indonesia, in 2001-2002. Tropical Medicine & International Health, 17(4), 455–461. doi:10.1111/j.1365-3156.2011.02949.x