Antimicrobial susceptibility of Enterobacteriaceae, including molecular characterization of extended-spectrum beta-lactamase-producing species, in urinary tract isolates from hospitalized patients in North America and Europe: results from the SMART study 2009-2010.

In 2009-2010, 3646 urinary tract isolates of Enterobacteriaceae spp. were isolated from hospitalized patients in North America and Europe. Extended-spectrum beta-lactamase (ESBL) production was detected in 8.5% and 8.8% of Escherichia coli and Klebsiella pneumoniae, respectively, in North America and in 17.6% and 38.9% for Europe, respectively. The carbapenems (ertapenem and imipenem) were the most active agents in vitro, with ampicillin-sulbactam the least active. Molecular characterization of about 50% of ESBL-positive isolates identified the presence of bla(CTX-M) genes in over 90% of Escherichia coli from both continents. bla(KPC) was more common in North American isolates of K. pneumoniae than in European isolates (21.4% versus 6.9%). bla(TEM) and AmpC genes were infrequent. Enterobacteriaceae spp. isolated from hospitalized patients with urinary tract infections in both North America and Europe are often resistant to commonly used antimicrobials with bla(CTX-M) genes common in both Escherichia coli and K. pneumoniae.