molecular characterisation of trimethoprim resistance in escherichia coli and klebsiella pneumoniae during a two year intervention on trimethoprim use分子描述在大肠杆菌和肺炎克雷伯菌耐甲氧苄氨嘧啶甲氧苄氨嘧啶使用两年的干预.pdfVIP

Molecular Characterisation of Trimethoprim Resistance in Escherichia coli and Klebsiella pneumoniae during a Two Year Intervention on Trimethoprim Use 1 2,3 2,4 1 Alma Brolund *, Martin Sundqvist , Gunnar Kahlmeter , Malin Grape 1 Department of Microbiology, Tumor and Cell Biology (MTC), Division of Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden, 2 Department of Clinical ¨ ¨ Microbiology, Central Hospital, Vaxjo, Sweden, 3 Division of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden, 4 Division of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden Abstract Background: Trimethoprim resistance is increasing in Enterobacteriaceae. In 2004-2006 an intervention on trimethoprim use was conducted in Kronoberg County, Sweden, resulting in 85% reduction in trimethoprim prescriptions. We investigated the distribution of dihydrofolate reductase (dfr)-genes and integrons in Escherichia coli and Klebsiella pneumoniae and the effect of the intervention on this distribution. Methodology/Principal Findings: Consecutively isolated E. coli (n = 320) and K. pneumoniae (n = 54) isolates phenotypicaly resistant to trimethoprim were studied. All were investigated for the presence of dfrA1, dfrA5, dfrA7, dfrA8, dfrA12, dfrA14, dfrA17 and integrons class I and II. Isolates negative for the seven dfr-genes (n = 12) were also screened for dfr2d, dfrA3, dfrA9, dfrA10, dfrA24 and dfrA26. These genes accounted for 96% of trimethoprim resistance in E. coli and 69% in K. pneumoniae. The most prevalent was dfrA1 in both species. This was followed by dfrA17 in E. coli which was only found in one