Journal Article

Phenotypic and genotypic aminoglycoside resistance in blood culture isolates of coagulase-negative staphylococci from a single neonatal intensive care unit, 1989–2000

Claus Klingenberg, Arnfinn Sundsfjord, Arild Rønnestad, Jarle Mikalsen, Peter Gaustad and Trond Flægstad

in Journal of Antimicrobial Chemotherapy

Published on behalf of British Society for Antimicrobial Chemotherapy

Volume 54, issue 5, pages 889-896
Published in print November 2004 | ISSN: 0305-7453
Published online November 2004 | e-ISSN: 1460-2091 | DOI: http://dx.doi.org/10.1093/jac/dkh453
Phenotypic and genotypic aminoglycoside resistance in blood culture isolates of coagulase-negative staphylococci from a single neonatal intensive care unit, 1989–2000

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Objectives: To investigate the prevalence of aminoglycoside resistance and genes encoding aminoglycoside-modifying enzymes (AME) in blood culture isolates of coagulase-negative staphylococci (CoNS) from neonates.

Materials and methods: A total of 180 isolates from 148 patients collected in a single neonatal unit over a 12 year period were examined for susceptibility to gentamicin, tobramycin, netilmicin, amikacin and arbekacin by Etest and/or disc diffusion. AME genes were detected by PCR.

Results: The overall non-susceptibility rates to gentamicin, tobramycin, netilmicin, amikacin and arbekacin were 66%, 68%, 52%, 38% and 1%, respectively. Gentamicin non-susceptibility rates were 4% and 91% in methicillin-susceptible and -resistant isolates, respectively. aac(6′)-Ie-aph(2″)-Ia, aph(3′)-IIIa and/or ant(4′)-Ia were encountered in 125 (69%), 1 (0.5%) and 30 (16.6%) isolates, respectively. Forty-six (26%) isolates negative for AME genes were susceptible to all aminoglycosides. In contrast, 115 (92%), 91 (73%) and 66 (53%) of aac(6′)-Ie-aph(2″)-Ia positive isolates were non-susceptible to gentamicin, netilmicin and amikacin, respectively. Only one isolate showed arbekacin resistance. However, aac(6′)-Ie-aph(2″)-Ia positive isolates and isolates with gentamicin MIC ≥128 mg/L displayed a significant reduction in arbekacin inhibition zones.

Conclusions: A high prevalence of aminoglycoside resistance was detected and associated with methicillin resistance. Discrepancies between phenotypic and genetic detection of aminoglycoside resistance were discerned. Gentamicin was the preferred substrate for phenotypic detection of aac(6′)-Ie-aph(2″)-Ia. Arbekacin showed favourable antibacterial activity even in aac(6′)-Ie-aph(2″)-Ia-positive isolates. We suggest including arbekacin in future clinical trials of empirical treatment of late onset neonatal sepsis.

Keywords: arbekacin; aminoglycoside-modifying enzymes; methicillin resistance

Journal Article.  4971 words.  Illustrated.

Subjects: Medical Oncology ; Critical Care

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