CTX-M extended-spectrum beta-lactamases among clinical isolates of Enterobacteriaceae in a Thai university hospital.

This study presents updates on molecular epidemiology of extended-spectrum beta-lactamases (ESBLs) in clinical isolates of Enterobacteriaceae from Srinagarind Hospital, Khon Kaen University, Thailand. All isolates were screened for the presence of ESBL genes, bla(TEM), bla(SHV), bla(VEB) and bla(CTX-M), using PCR followed by nucleotide sequence determination. The results revealed that beta-lactamase genes among 48 isolates collected between 1998 and 1999 were bla(SHV) (79%), bla(CTX-M-9) (52%), bla(TEM-1) (48%) and bla(VEB) (33%), whereas those found in 52 isolates collected in 2003 were bla(TEM-1) (79%), bla(CTX-M-15) (44%), bla(SHV) (36%), bla(VEB) (36%), bla(CTX -M-14) (11%) and bla(CTX-M-9) (10%). In addition, 45 isolates carried at least two different ESBL genes. Using PCR, part of insertion sequence ISEcpl was found in the upstream regions of bla(CTX-M-14) and bla(CTX-M-15). ERIC-PCR analysis revealed that most ESBL-producing isolates were of different strains. This is the first report of CTX-M-9, CTX-M-14 and CTX-M-15 beta-lactamase genes in Enterobacteriaceae in Thailand.

Detection of heterogeneous, intermediate-vancomycin-resistant Staphylococcus aureus (hVISA) using low-concentration vancomycin disks.

Heterogeneous, intermediate-vancomycin-resistant Staphylococcus aureus (hVISA) represents a threat of an incurable infection since the first report in 1997. The method used to detect hVISA isolates is a population analysis profile (PAP); however, it is impractical for routine laboratory analysis. We therefore tested a simple, reliable and inexpensive method for the detection of hVISA. Eighteen isolates of hVISA and 22 of vancomycin-sensitive S. aureus (VSSA) were included. The organisms were tested by the disk diffusion method, using 15-microg vancomycin disks on four different media: Mueller-Hinton agar (MHA), MHA plus 2% NaCI (MHAS), Brain Heart Infusion agar (BHA), and BHA plus 2% NaCl (BHAS). In addition, two different inoculum sizes, bacterial suspensions adjusted to 0.5 and 2.0 McFarland, were tested. The inhibition zone was read independently by three medical technologists after incubation at 37 degrees C for 24 and 48 hours. The use of MHAS with an inoculum size of 2.0 McFarland and 48-hour incubation period yielded the highest sensitivity (94.4%), specificity (81.8%), positive predictive value (80.9%), and negative predictive value (94.7%). The disk diffusion test with 15-microg vancomycin disk is simple and may be used as a screening method for the detection of hVISA.