3) 2 (4.1) 2 (4.1) 6 (12.2) 14 (28.6) 8 (16.3) 5 (10.2) 2 (4.1) 1 (2) 27 (55.1) 10 (20.4) 10 (20.4) 2 (4.1) *Other: CSF, sputum. IPM: Pasteur Institute Medical Laboratory. HJRA: Joseph Ravoahangy Andrianavalona Hospital. HOMI: Military Hospital. Antimicrobial susceptibility analyses showed that all isolates were resistant to all

the β-lactams used but were Selleckchem LB-100 susceptible to cefoxitin and imipenem. Resistance to cefoxitin in all E. cloacae isolates was due to the inducible production of AmpC β-lactamase from a chromosomal gene. All ESBL-producing isolates were also multidrug-resistant and most of them were resistant to: aminoglycosides (87.7% to gentamicin, 93.8% to tobramycin), trimethoprim-sulfamethoxazole (100%) and quinolones (75.5% to nalidixic acid, 69.3% to ciprofloxacin). Molecular epidemiology ERIC-PCR and rep-PCR analyses

revealed different restriction patterns for each isolate and showed that they were not clonally related (data not shown). Molecular NU7026 nmr analysis Nucleotide sequence analysis of the bla CTX-M and bla SHV genes showed that only the CTX-M-15 and SHV-12 genes were present in these isolates. Only TEM-1 and OXA-1 were identified in the TEM- and OXA-producing isolates. The CTX-M-15 gene was detected in 37 isolates (75.5%) and the SHV-12 gene in 19 (38%). The ISEcp1 insertion sequence was identified in all 37 bla CTX-M-carrying isolates. Of the 37 isolates positive click here for CTX-M-15, ten (27%) also carried only TEM-1, nine (24.3%) also carried

only OXA-1, and 16 (43.2%) carried TEM-1 and OXA-1 genes (Table 1). Of the 19 SHV-12-positive isolates, six (31.6%) also carried only TEM-1, four (20.1%) also carried only OXA-1 and six (31.6%) carried TEM-1 and OXA-1 genes (Table 1). Eight isolates (16.3%) (two E. coli, five K. pneumoniae and one E. cloacae) carried both bla CTXM-15 and bla SHV-12 and six of Obeticholic Acid mouse these were additionally TEM-1- and OXA-1-positive. The resistance genes most frequently present were aac(6 ′ )-Ib (n=35, 71.4%) (33 were aac(6 ′ )-Ib-cr, 67.3%), sul1 and sul2 (n=25, 51%), tetA (n=24, 48.9%), qnrB (n=12, 24.5%) and qnrA (n=1, 2%). Among the six isolates carrying bla CTXM-15, bla SHV-12, bla TEM-1 and bla OXA-1, all of these also carried aac(6 ′ )-Ib (5 were aac(6 ′ )-Ib-cr), sul1-sul2, and five harbored tetA. Overall β-lactam resistant isolates harbored β-lactamases genes (CTX-M-15, SHV-12, TEM-1 and/or OXA-1) as well as trimethoprim-sulfamethoxazole resistant isolates sulfamide genes (sul1 and/or sul2). Ten (27.8%) of ciprofloxacin resistant isolates and 3 (25%) of ciprofloxacin susceptible isolates were qnr positive. Twenty five (69.2%) of ciprofloxacin resistant isolates and 8 (61.5%) of ciprofloxacin susceptible isolates were aac(6 ′ )-Ib-cr positive And, 27 (71%) of amikacin susceptible isolates and 8 (72.7%) of amikacin resistant isolates were aac(6 ′ )-Ib positive. Forty-eight isolates were positive for the class-1 integron gene and it was absent in only one K.