Occurrence and molecular analysis of extended-spectrum β-lactamase-producing Proteus mirabilis in Hong Kong, 1999–2002

OBJECTIVES

A study was conducted to evaluate the occurrence and characterization of extended-spectrum beta-lactamases (ESBLs) among blood isolates of Proteus mirabilis collected over a 4 year period in Hong Kong.

METHODS

Production of ESBLs among 99 consecutive and non-duplicate isolates was evaluated by the double-disc synergy test. The ESBLs were characterized by isoelectric focusing and PCR sequencing using specific primers. The epidemiological relationship of the isolates was studied by the Dienes test and PFGE.

RESULTS

ESBLs were identified in 13 isolates, from none in 1999-2000 and up to 18.5% (5/27) in 2001 and 25.8% (8/31) in 2002. The ESBL-producing isolates were more resistant to ceftriaxone than to ceftazidime, and were more likely than non-ESBL-producers to have resistance to ciprofloxacin (76.9% versus 14%) and gentamicin (38.5% versus 9.3%). The ESBL content included CTX-M-13 (n=8), CTX-M-14 (n=3), SHV-5 (n=2), TEM-11 (n=1), and an unidentified ESBL with a pI of 7.5. The Dienes test revealed that the genetic background in the 99 isolates was highly heterogeneous, with 54 distinct types among 92 isolates and seven were non-typeable. Among the 13 ESBL-producing isolates, five different backgrounds, including one cluster (Dienes-pulsotype A) with nine isolates, were identified by both Dienes test and PFGE, thus suggesting both clonal and multi-clonal spread of the CTX-M enzymes.

CONCLUSIONS

Our findings indicate the emergence of CTX-M enzymes among P. mirabilis in Hong Kong. More ESBL screening of this species is required to improve their recognition.

Detection and characterization of extended-spectrum β-lactamases among bloodstream isolates of Enterobacter spp. in Hong Kong, 2000–2002

OBJECTIVES

A total of 139 consecutive and non-duplicate bloodstream isolates of Enterobacter spp. collected from inpatients in Hong Kong during 2000-2002 were studied for production of extended-spectrum beta-lactamases (ESBLs).

METHODS

All isolates were evaluated by the modified double-disc synergy test (m-DDST), the combined disc method (CDM) and the three-dimensional (3D) test. The m-DDST and CDM were modified by the use of cefepime discs. beta-Lactamases were characterized by isoelectric focusing and PCR sequencing using specific primers.

RESULTS

ESBLs were identified in nine isolates (overall 6.5%), including seven of 39 (17.9%) Enterobacter hormaechei, one of 27 (3.7%) Enterobacter aerogenes and the only Enterobacter intermedius strain. The E. intermedius strain was positive only in the 3D test but not in the other two tests. The other eight strains were positive in all three tests. No ESBL was detected in the other species, including non-hormaechei members of the Enterobacter cloacae complex (n=61), Enterobacter agglomerans (n=7), Enterobacter gergoviae (n=4) and Enterobacter sakazakii (n=1). The ESBL content included five different CTX-M enzymes (CTX-M-9, CTX-M-13, CTX-M-14, CTX-M-24 and a novel CTX-M-2-like beta-lactamase), SHV-12 (n=2) and unidentifiable ESBLs with a pI of 7.7 or 7.9 in two strains. The seven ESBL-producing E. hormaechei were genotyped by pulsed-field gel electrophoresis and were found to be unrelated to each other. In three of the CTX-M-producing strains, ISEcp1-like elements, including promoters for the beta-lactamase gene, were found.

CONCLUSIONS

Our data underscore the diversity of CTX-M enzymes among Enterobacter spp. in Hong Kong.

Depth-controlled beta-NMR of 8Li in a thin silver film

Depth-controlled beta-NMR can be used to probe the magnetic properties of thin films and interfaces on a nanometer length scale. A 30 keV beam of highly spin-polarized 8Li+ ions was slowed down and implanted into a 50 nm film of Ag deposited on a SrTiO3 substrate. A novel high field beta-NMR spectrometer was used to observe two well resolved resonances which are attributed to Li occupying substitutional and octahedral interstitial sites in the Ag lattice. The temperature dependence of the Knight shifts and spin relaxation rates are consistent with the Korringa law for a simple metal, implying that the NMR of implanted 8Li reflects the spin suspectibility of bulk metallic silver.

Muonium as a shallow center in GaN

A paramagnetic muonium (Mu) state with an extremely small hyperfine parameter was observed for the first time in single-crystalline GaN below 25 K. It has a highly anisotropic hyperfine structure with axial symmetry along the <0001> direction, suggesting that it is located either at a nitrogen-antibonding or a bond-centered site oriented parallel to the c axis. Its small ionization energy (<or=14 meV) and small hyperfine parameter (approximately 10(-4) times the vacuum value) indicate that muonium in one of its possible sites produces a shallow state, raising the possibility that the analogous hydrogen center could be a source of n-type conductivity in as-grown GaN.

Cross-reaction of anti-simian immunodeficiency virus envelope protein antibodies with human immunoglobulins

It has been recently established that retroviral envelope proteins (REPs) have structural features similar to those of immunoglobulins (Igs). In this study, we asked whether anti-REP antibodies cross-react with human Igs (hIgs). To this end, murine monoclonal antibodies (mMoAbs) that had been raised against a simian immunodeficiency virus (SIV) envelope protein, SIVMac251gp120, were screened for their ability to react with human monoclonal Igs (HMIgs). We show that two HMIgs, RFSJ2 (a rheumatoid factor) and PAMLN6 (a human anti-hIg V region antibody), but not a number of other HMIgs, could be weakly, but consistently, bound by anti-SIVMac251gp120 mMoAbs KK17 and KK46, as judged by indirect enzyme-linked immunosorbent assay and a liquid-phase inhibition immunoassay. Both mMoAbs are specific to amino acid residues in the V3 loop of the SIVMac251gp120. The RFSJ2 Ig heavy-chain V region (VH) is coded in part by a human VH gene, VH3-30.3 and includes the idiotope 7B4 (NKYY), which was previously shown to be present in the gp120 protein of a number of HIV-2 and SIV strains. However, an entirely different VH gene codes the PAMLN6 VH region, opening the possibility that epitope(s) shared between SIVMac251gp120 and hIgs may not be limited to the 7B4 idiotope.

Muonium analog of hydrogen passivation: observation of the Mu+-Zn- reaction in GaAs

We report direct detection of the formation and subsequent breakup of a complex containing positively charged muonium ( Mu+) and a substitutional Zn(Ga) acceptor in heavily doped p-type GaAs:Zn. Mu+ diffuses above 200 K with a hop rate nu = nu(0)e(-E(nu)/k(B)T) where nu(0) = (7.7+/-2.0)x10(8) s(-1) and E(nu) = 0.15(4) eV. Above 350 K, it forms the complex with a trapping radius of 500+/-200 A. The Mu-Zn complex breaks up above 550 K with a dissociation energy of 0.88(7) eV and prefactor of (5+/-4)x10(12) s(-1). Above 750 K, the cyclic reaction Mu+<--> Mu0 takes place.

Detection of RTX toxin gene in Vibrio cholerae by PCR

A PCR that amplifies a recently discovered Vibrio cholerae RTX (repeat in toxin) toxin gene was developed. Among 166 clinical and environmental isolates of V. cholerae causing epidemics and sporadic cases of cholera in various parts of the world, all were found to be toxigenic by both PCR and HEp-2 cell cytotoxicity assay. Standard strains of the classical biotype containing a deletion within the gene cluster exhibited negative results by both assays. This is the first rapid genotyping method for differentiation of V. cholerae O1 classical biotype strains from El Tor biotype strains as well as strains of other non-O1 serogroups including serogroup O139. The PCR assay that was developed also specifically detects RTX toxin genes in V. cholerae, as clinical isolates of Vibrio parahaemolyticus, diarrheagenic Escherichia coli, Aeromonas species, and Plesiomonas species were all negative by the RTX toxin-specific PCR as well as the HEp-2 cytotoxicity assay. These findings highlight the characteristics of the RTX toxins in V. cholerae. Their role in the pathogenicity of the bacterium requires further investigation.

Detection of interstitial Ga in GaN

We report the direct detection of interstitial Ga by optical detection of electron paramagnetic resonance (ODEPR) in the photoluminescence of n-type GaN after irradiation in situ at 4.2 K with 2.5 MeV electrons. It is stable upon annealing until room temperature, where it becomes mobile and trapped to form a new defect which is observed to emerge as the interstitial disappears. The time constant of the process at room temperature is approximately 200 min. The emergence of another ODEPR center beginning at approximately 135 K suggests even easier migration of one of the other intrinsic defects in the GaN lattice.

Novel behavior of bond-centered muonium in heavily doped n-type silicon: Curie-like spin susceptibility and charge screening

Bond-centered muonium ( Mu(0)(BC)) has been observed in very heavily doped n-type Si:P. It exhibits a Curie-like electronic spin susceptibility which leads to a giant negative shift in the muon spin precession frequency. At high dopant levels, the Mu(0)(BC) hyperfine parameters, deduced from a model involving spin exchange with free carriers, are significantly reduced from those in intrinsic Si. This indicates that the spin density distribution for Mu(0)(BC) in metallic Si:P is altered significantly by charge screening effects, likely a general phenomenon for deep impurities in materials with high carrier concentrations.

Emergence of fluoroquinolone resistance among multiply resistant strains of Streptococcus pneumoniae in Hong Kong

The MICs of 17 antimicrobial agents for 181 Streptococcus pneumoniae strains were determined by the E-test. Overall, 69.1% were penicillin resistant (MIC > 0.06 microgram/ml). Resistance to ciprofloxacin (MIC > 2 microgram/ml), levofloxacin (MIC > 2 microgram/ml), or trovafloxacin (MIC > 1 microgram/ml) was found in 12.1, 5.5, or 2.2% of the strains, respectively. These high rates of resistance raise concerns for the future.

Comparison of a novel, inhibitor-potentiated disc-diffusion test with other methods for the detection of extended-spectrum beta-lactamases in Escherichia coli and Klebsiella pneumoniae

A novel, inhibitor-potentiated disc-diffusion test for detecting extended-spectrum beta-lactamases (ESBLs) in bacteria was evaluated. This test uses the principle of augmentation (by > or = 10 mm) of inhibition zones produced by ceftazidime, cefotaxime, ceftriaxone or aztreonam discs on Mueller-Hinton agar supplemented with clavulanate (4 mg/L). The test was initially compared with the double-disc synergy test, Kirby-Bauer disc-diffusion test and Etest ESBL screen with a panel of 45 reference strains with known resistance profiles. This panel consisted of 27 ESBL-positive Escherichia coli strains expressing 14 Bush group 2be enzymes and 18 other E. coli and Klebsiella pneumoniae strains (14 non-ESBL beta-lactamase producers and four non-beta-lactamase producers). The Kirby-Bauer disc-diffusion test was the least sensitive method: 11-44% of the ESBL-positive control strains were misclassified as susceptible to ceftazidime, cefotaxime, ceftriaxone or aztreonam when interpreted by National Committee for Clinical Laboratory Standards (NCCLS) criteria. The sensitivities of the inhibitor-potentiated disc-diffusion test, the double-disc synergy test (when discs were 25 or 30 mm apart) and the Etest ESBL screen (with a breakpoint of > 4-fold reduction in ceftazidime MIC in the presence of clavulanate) were 100%, 96% and 89-96%, respectively. The inhibitor-potentiated disc-diffusion test was further evaluated with 81 E. coli and K. pneumoniae clinical isolates, which were identified as putative ESBL-producers by the double-disc synergy test. For these isolates, the sensitivity of both the inhibitor-potentiated disc-diffusion test and the Etest ESBL screen was 100%. In conclusion, the inhibitor-potentiated disc-diffusion test is a sensitive, convenient and inexpensive method of screening for ESBLs in E. coli and K. pneumoniae isolates, with potential for incorporation into routine clinical laboratory service.