Emergence of Extended-Spectrum β-Lactamase PER-1 in Proteus vulgaris and Providencia stuartii Isolates from Algiers, Algeria

Antimicrobial Agents and Chemotherapy
2009.0

Abstract

PER β-lactamases are one of the rarer extended-spectrum β-lactamase (ESBL) families; however, their prevalence is increasing. PER-1 was mainly detected in Europe and Asia, while data on its diffusion in Africa are virtually nonexistent, and its host genera are usually Pseudomonas, Acinetobacter, and Providencia. We report the emergence of the PER-1 ESBL in Proteus vulgaris (n=4) and Providencia stuartii (n=1) clinical isolates from an Algiers public hospital. The isolates were identified by the API 20E system, and antimicrobial susceptibility testing by disk diffusion and Etest showed resistance to ceftazidime (MIC ≥256 μg/ml), intermediate resistance to piperacillin, cefotaxime, and cefepime, and susceptibility to imipenem. A synergetic effect between clavulanic acid and ceftazidime indicated ESBL production. PCR and sequencing revealed the presence of blaPER-1. Enterobacterial repetitive intergenic consensus-PCR typing showed similar patterns for P. vulgaris isolates, suggesting clonal expansion. Conjugation studies demonstrated blaPER-1 was transferable and located on a 100-kb plasmid, which conferred additional resistances for P. vulgaris (trimethoprim, trimethoprim-sulfamethoxazole, kanamycin) and P. stuartii (trimethoprim). The genetic environment analysis showed ISPa12 was present upstream of blaPER-1 in all isolates, but ISPa13 was not identified. This first report of PER-1 in these two enterobacterial species from Algiers indicates the blaPER-1 gene has spread south of the Mediterranean and perhaps even to Africa.

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